Inspection on 17/11/08 for Grosvenor House Nursing Home

This inspection was carried out on 17th November 2008.

CSCI found this care home to be providing an Excellent service.

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 12/12/06

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 31/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Grosvenor House Nursing Home 39 Duchy Road Harrogate North Yorkshire HG1 2HA     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jo Bell     Date: 1 7 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 25 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Grosvenor House Nursing Home 39 Duchy Road Harrogate North Yorkshire HG1 2HA 01423523447 01423527672 grosvenor.house@ashbourne-homes.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Apta Healthcare (UK) Ltd care home 50 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category terminally ill Additional conditions: 5 day care places 60 years upwards Age 45 years plus - TI Age range 60 years plus - OP Date of last inspection Brief description of the care home 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. 0 4 Over 65 46 0 Care Homes for Older People Page 4 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We have reviewed our practice when making requirements,to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations,but only when it is considered that people who use services are not being put at significant risk of harm. In future,if a requirement is repeated,it is likely that enforcement action will be taken. We went to the home without telling them that we were going to visit. This report follows the visit that took place on Monday 17th November 2008 October 2008. The visit lasted from 10:00am until 14:30pm. The purpose of the visit was to make sure that the home was operating and being Care Homes for Older People Page 5 of 25 managed in the best interests of people living there. Information has been used from different sources for this report. These sources include- Reviewing information that has been received about the home since the last inspection. The annual quality assurance assessment. This is information which details what has happened during the past 12 months. 18 Surveys from people using the service, 5 staff surveys and 1 healthcare professional survey was returned. Notifications (Regulation 37) relating to incidents in the home affecting people using the service. Details of complaints and allegations raised by people connected to the service. Progress of the previous recommendations made at the last site visit. At the site visit one inspector spent 4.5 hours at the home. During this time observations of care practices took place. People using the service were spoken with along with some relatives. Discussions with the manager regarding meeting needs, mealtimes, protecting people and the environment took place. The lunchtime meal was observed and time was spent inspecting care plans, looking at individual rooms and reviewing a selection of health and safety information. Staffing and management issues were discussed and feedback was given to the manager at the end of the inspection. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 7 of 25 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 8 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are effectively assessed prior to admission, which helps to ensure individual needs can be met. Evidence: The three pre-admission assessments looked at confirmed that a senior person completes an assessment before an individual moves to the home. This is to check what type of care and support the person needs and whether the staff have the skills and knowledge to provide that care if the individual chooses to move there. The process also reassures the individual and their family that they will receive the right support. The Annual Quality Assurance Assessment states All service users have a comprehensive assessment by the home manager or care manager in the home to ensure their needs can be met, that is, having in place appropriate accommodation, Care Homes for Older People Page 9 of 25 Evidence: equipment and skills in the home before a place is offered. A pre-admission care-plan is formulated following the assessment to ensure a stress free transition period and continuation of care. Care Homes for Older People Page 10 of 25 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have their health and personal care needs met in a dignified manner. Evidence: Four care plans were looked at during this visit. These describe the care and support people need to stay in charge of their own lives as much as possible. The plans looked at contained a lot of information, so that an unfamiliar carer could look at them and would be able to work out how much support they needed. There were written assessments as to whether people were at risk of developing pressure sores, of losing weight because of poor appetite or a health problem or needing help with moving and handling. Those identified as at risk had a care plan in place describing how that risk was to be managed. People that were observed looked well cared for, nails and teeth looked clean and people looked well hydrated. Care plans had been reviewed and evaluated and staff are aware of how to manage pressure sores, poor nutrition and accidents in thehome. One person said I see my doctor when I am not very well. Care Homes for Older People Page 11 of 25 Evidence: The Annual Quality Assurance Assessment confirms that each person has a detailed and comprehensive plan of care formulated to meet their individual needs. The home encourages the person using the service and their relatives to be actively involved. The home obtains specialist advice from the multi-disciplinary team, this helps ensure needs are fully met. The medication system was inspected. Four medication charts showed that people are receiving their medication and staff are recording this effectively. A monitored dosage system is used and this is safely stored and disposed of. The controlled drugs book is well-maintained and the room to store medicines is kept secure. Privacy and dignity in the home was observed. Staff were interacting positively with people using the service. Staff understand how to care for people at the end of their life and the pleasant attitude and manner of staff enhances this. Care Homes for Older People Page 12 of 25 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People participate in a range of activities and visitors are welcomed. Staff encourage autonomy and choice, and people enjoy dining in pleasant surrounding with appealing food. Evidence: The home has an activities organiser and people are able to participate in a wide range of activities. The Annual Quality Assurance Assessment states, The home has a mini bus and regular trips are arranged to include events taking place in the community. Trips have included going to The Great Yorkshire show, Harrogate Flower show, the pantomime, visiting local beauty spots like the Valley Gardens and the nearby Dales. The home produces a three monthly newsletter and this contains photographs of trips, details of new staff working in the home, quizzes and crosswords and improvements to the home. There is a relaxation room for people to spend time in, this is a comfortable lounge with a fish tank, lava lamps, pictures to relax people and different colored lights and sounds. A pamper room is also planned for the future. The home has links with local churches, local schools visiting mobile library, and Tea and Talk in the community. A drama and singing group provide entertainment in the home, and there is a keep fit therapist. The Annual Quality Assurance Assessment also states We have Care Homes for Older People Page 13 of 25 Evidence: a large easily accessible landscaped garden for the service user, friends and relatives to relax and enjoy. We have the ladies from the University of the third age holding different small groups in the home and service users can attend, example: a scrabble group, poetry group, Italian and German group. All these activities give people the opportunity to revisit hobbies they may have previously enjoyed and they can develop new interests. Autonomy and choice is encouraged and whilst there are many social aspects to participate in these are all optional. People also have access to the local advocacy service for extra support or advice as needed. The lunchtime meal was observed which looked nutritious and appealing. The dining experience for people was pleasant. Meals are devised using a system where nutritional values are worked out. This helps to ensure people are getting the right type of food and drink on a daily basis. The menu offered a variety of food for people to choose from. For example at breakfast time cereal, porridge, a cooked breakfast, or toast and marmalade. Staff are aware of how to cater for people with special dietary requirements, and people who need assistance at mealtimes are helped in a dignified and respectful manner. Culutural and religous needs can be catered for and staff are aware of different needs. The home is keen to produce home made food for everyone to enjoy. This was evident at lunchtime. The catering staff have completed food hygiene training and confiremd that the las visit from environmental health was very positive. Care Homes for Older People Page 14 of 25 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have their concerns listened to and acted upon, with staff been alert to signs of abuse Evidence: The home have a complaints procedure in place which people and their visitors are aware of. This is discussed at the admission stage and a copy of this is displayed in the home. During the past 12 months the home have received six formal complaints, of these 2 were upheld. One person said I would speak to a member of staff if I was not happy (but I really like it here.) Another person said I am well looked after, but staff listen to any concerns I have. Staff spoken to were aware of the safeguarding procedures in place. Some staff have completed abuse awareness training,and staff knew about the different types of abuse and the action to take if an abusive situation occurs.The home have a policy in place and staff are encouraged to use the Whistle Blowing policy. The Annual Quality Assurance Assessment states All staff receive residents welfare training during their induction period. Several senior members of staff have attended external training safeguarding level 1 alerter sessions provided by North Yorkshire and York County Council. The training pack facilitated in the home on abuse is very comprehensive and highlights all aspects in the prevention and recognition of abuse. Care Homes for Older People Page 15 of 25 Evidence: In the last 12 months we have not had any suspicion of abuse reported in the home. This was confirmed during the site visit. Care Homes for Older People Page 16 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a comfortable and clean environment. Evidence: People live in a clean and homely environment. A plan of routine maintenance and redecoration is in place and the home is decorated to a good standard throughout. The home has several communal areas, which include a TV Lounge, Relaxation room, Garden Suite Conservatory Lounge and a small lounge for people upstairs. There is a large dining room and a small smoking lounge. The home has 2 communal bathrooms which also have a shower cubicle or a wet room. The home is surrounded by large well maintained landscaped gardens and patio area with outdoor furniture and seating. There is access for wheelchairs and equipment and aids are available for people who need help with their mobility. This was discussed in the Annual Quality Assurance Assessment and confirmed at the site visit. Four bedrooms were inspected, these were a good size with pleasant views and people spoken with confirmed they were regularly cleaned. The majority of domestic staff have generally received infection control training and staff are aware of how to deal with spillages. Staff were observed washing their hands and wearing protective aprons at different times during the day. People using the service were observed wearing clean and well-ironed clothes and positive comments were received regarding Care Homes for Older People Page 17 of 25 Evidence: cleanliness in the home. Care Homes for Older People Page 18 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are cared for by staff who are competent, well trained and recruited and in sufficient numbers to meet individual needs. Evidence: On the day of the site visit there were twenty six older people residing in the home. The staffing levels are generally two registered nurses and up to five carers on a morning, there is one carer less on an afternoon and evening, then overnight staffing levels are one registered nurse and two carers. The Annual Quality Assurance Assessment confirms that people have a range of needs, some people have dementia whilst others have nursing needs. The majority of staff are female and the home employs staff from different cultures and backgrounds. The home is able to meet individual needs are staff are well trained and competent to carry out their roles and responsibilities. Care staff are expected to complete and NVQ Level 2 in care (this is highlighted in the newsletter) and all staff complete a comprehensive induction programme within 3 months of them starting work. This is followed by on going training and development. This helps to ensure people are all working to a good standard. The induction programme is equivalent to Skills for Care and covers care practises, health and safety and orientation to the home. Care Homes for Older People Page 19 of 25 Evidence: The manager is aware of how to recruit people effectively. Three staff files were inspected and these contained two written references, a police check and a protection of vulnerable adults check. Staff spoken with were aware of the checks needed and how the induction programme works. Comments from people using the service included the staff are wonderful here, the staff are really kind and caring. The surveys received also confirmed that staff have the right skills and experience. The home vary rarely needs to use additional staff, this means that people have a consistent service from regular staff. This makes people more confident and assured about the care they receive. Care Homes for Older People Page 20 of 25 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clearly run in the best interests of the people using the service. Evidence: The manager is registered with The Commission and has completed a management level qualification. She is an experienced manager with over thirty three years experience in a social care setting. The atmosphere in the home is calm and relaxing and visitors feel they can approach the manager and staff if they have any concerns. The manager has a good understanding of the business plan and how this fits within the home. The manager is aware of the different equality and diversity issues and promotes this throughout the home, some staff have received training in this area. One person said I like living here, I have everything I need, another comment was I am really happy in this home. The home have a quality assurance system in place which includes client and visitor questionnaires. The Annual Quality Assurance Assessment states We send out yearly Care Homes for Older People Page 21 of 25 Evidence: customer surveys to both residents and relatives. These are collated and analysed and the results are displayed within the home. Comments are acted upon for the improvement of the service. A senior manager also visits monthly and speaks to people using the service and identifies what improvements have been made. Records of these visits were available. Recruitment and staff files are audited on a regular basis and audits relating to complaints, accidents, pressure sores, nutrition and medication are in place. The home is keen to identify peoples likes and dislikes in the home and follow up action is taken to continuously improve the home. People can keep personal money in the home. This may be used for chiropody, hairdressing, clothes or toiletries.Well-maintained records are kept of all transactions and invoices are available which confirm the money coming in and going out. Three records were checked and the system was clear and effective. People spoken with spoke about how they can access their money and the information they receive from the home. The home have an up to date insurance certificate in place and are aware of how much money the home can keep. Health and safety in the home was discussed, a range of risk assessments are in place to reduce the risk of harm to people from accidents or injuries. People looked safe and comfortable and staff have undertaken mandatory training in areas including fire safety, moving and handling, infection control, food hygiene and first aid. A detailed fire risk assessment is in place and staff spoken with knew what action to take in the event of a fire. The home have up to date gas and electrical wiring certificates and water temperates are within the expected levels. The home is pro-active in monitoring its health and safety procedures through detailed audits and daily observations of the home. This helps to promote peoples well-being. Care Homes for Older People Page 22 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 9 The medicaiton trolley should be kept with the person administering the medication, this will kepp it secure. Care Homes for Older People Page 24 of 25 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 25 of 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!