Inspection on 06/12/07 for Grosvenor House Nursing Home

This inspection was carried out on 6th December 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Grosvenor House Nursing Home 01/09/06

Grosvenor House Nursing Home 29/07/05

Grosvenor House Nursing Home 17/01/05

Grosvenor House Nursing Home 22/04/04

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 Aqueduct Lane Alvechurch Nr Birmingham West Midlands B48 7BS Lead Inspector Yvonne Reay Key Unannounced Inspection 6th December 2007 10.00 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 DS0000004111.V355297.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 DS0000004111.V355297.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Grosvenor House Nursing Home Address Aqueduct Lane Alvechurch Nr Birmingham West Midlands B48 7BS 0121 447 7878 0121 0000000 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) www.alphacarehomes.com Alpha Health Care Limited vacant post Care Home 25 Category(ies) of Dementia - over 65 years of age (3), Old age, registration, with number not falling within any other category (25), of places Physical disability over 65 years of age (25) Grosvenor House Nursing Home DS0000004111.V355297.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st September 2006 Brief Description of the Service: Grosvenor House Nursing Home is situated within close proximity of Alvechurch, Barnt Green, the M42 motorway, Redditch and Bromsgrove. The home has recently been extended, and currently provides nursing care and accommodation for a maximum of twenty-five older people. Three of these places are registered for people with a dementia related illness. Accommodation is provided on two floors with a passenger lift and stairs providing access to first floor rooms. The home has nineteen single, en-suite rooms and three shared rooms all with en-suite facilities. Communal facilities are located on the ground floor and comprise of a lounge, dining room and conservatory and an additional lounge/dining room within the newly built extension. The home does not have internet access, but the organisation can be contacted via email on info@alphacarehomes.com Grosvenor House Nursing Home DS0000004111.V355297.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out over one day in December 2007.The Person in Charge (Manager Designate) was present for most of the inspection, however she was absent from the home from approximately 16.45 to 18.30 hours by mutual agreement. The Area Manager for Systems and Procedures was also present on the morning of the inspection. This is the first Key Inspection since a Random Inspection was carried out by CSCI in May 2007.The reason for the Random Inspection was to investigate allegations raised by an anonymous complainant. The complaint raised concerns about communication, staffing levels, cleanliness of the home, lack of activities and a damaged light. Requirements were made following this inspection; the findings are on file and are available on request. Feedback about the service has been received from a number of sources. 1.Staff surveys, and interviews with staff on the day of the inspection 2.Relatives’ surveys and conversations with relatives on the day of the inspection 3.Telephone conversations with relatives following the inspection 4.Conversations with people who use the service 5.Conversations with the Person in Charge on the day of the inspection 6.Feedback from other health professionals Direct comments and quotes from staff, relatives and people who use the service have been included in this report. Information gathered by CSCI at and since the Random Inspection in May 2007 and from the number of requirements made following this inspection indicates that the standards at the home have not been adequately monitored by the organisation in order to ensure the protection of the people who live there. Information supplied on the Annual Quality Audit Assessment (AQAA) document submitted by the organisation and received by CSCI on 15 August 2007 was in places contradictory, misleading and was not an accurate reflection of the home. For example the AQAA states that ‘The Registered Manager is competent and experienced as a senior manager’. The home does not currently have a Registered Manager in post. Since the previous Registered Manager left the home, temporary management arrangements have been in place. The Person in Charge on the day of the inspection (Manager Designate), who has been in post since August 2007, does not currently have sufficient management time in order to carry out her management tasks. There is no Deputy Manager in post. Grosvenor House Nursing Home DS0000004111.V355297.R01.S.doc Version 5.2 Page 6 It was possible however to evidence the accuracy of information from other areas of the AQAA at the key inspection. A letter of serious concern has been sent to the Responsible Individual following this inspection detailing matters requiring the urgent attention of the organisation. What the service does well: What has improved since the last inspection? The overall cleanliness of the home appears to have has improved since the Random Inspection in May 2007. A domestic had recently been employed. Records show that staff are receiving supervision and one nurse stated, “I did my adaptation here and I had an appraisal recently. I am not sure about residents meetings but we are having a staff meeting here tonight”. Grosvenor House Nursing Home DS0000004111.V355297.R01.S.doc Version 5.2 Page 7 There were indications that the person in charge is making some improvements to the standards of care at the home. One relative commented, “It is much better now –I am happy with the care, Julie and Jean have made a difference to my mothers care”. Some requirements remain outstanding from the last Random Inspection. What they could do better: The management arrangements are inadequate. The person in charge (Manager Designate) is allocated only two days a week in which to carry out management/administrative tasks and there is no Deputy in post to support her. The organisation must review these arrangements in order that the person who is in day to day control of the home has sufficient time and support to carry out all the management duties required for the efficient and effective running of the service. Staffing numbers are not always appropriate in order to meet the needs of the people who use the service and new staff do not always receive a full and comprehensive induction. Records required by regulation for the effective and efficient running of the home were not always available for inspection on the day of the visit. People who use the service are not fully protected by the homes management of allegations of abuse. In particular following a recent allegation of abuse there was a failing by the organisation to inform the Adult Protection Team. The Annual Quality Audit and Assessment document submitted by the organisation was contradictory and misleading in places. Consideration does not always appear to be given to the special social support required by individuals following an assessment of needs, in particular those with a physical disability or sensory impairment. A sample of comments from people who use the service: “Sometimes they are short of staff. I have to wait to be attended to and to wait to be taken from the dining room”. “Staff are kind and the food is ok but I do not have an appetite. I would like to be able to read but cannot. There is not much to do”. Comments from staff:“I did not have an induction but I have had all the mandatory training”. Grosvenor House Nursing Home DS0000004111.V355297.R01.S.doc Version 5.2 Page 8 Comments from relatives:“The home used to be good. They used to have good occupational therapy sessions – these have declined” “The standard of cleanliness is poor and my mother’s personal cleanliness could be better. The care has deteriorated over time. Maintenance and repairs could be a lot better”. “I visit the home and I feel things are Ok for XX. There could be more staff on duty as XX has to wait to be attended to at times – sometimes for a considerable length of time”. “The morale of the staff is low I feel - the home seemed to run well until the middle of this year”. 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 DS0000004111.V355297.R01.S.doc Version 5.2 Page 9 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 DS0000004111.V355297.R01.S.doc Version 5.2 Page 10 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): Standards 1 and 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is sufficient information available in order for people who use the service to make an informed choice about the home. People have their needs assessed before moving into the home. EVIDENCE: The home has sufficient information available to enable people who use the service to make an informed decision. However the statement of purpose needs to be consolidated into one concise, accurate working document, which fully reflects the service provision. There was evidence that pre admission assessments are carried out. And these were seen on those care files inspected. Standard 6 does not apply. Grosvenor House Nursing Home DS0000004111.V355297.R01.S.doc Version 5.2 Page 11 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): Standards 7,8 and 10 Quality in this outcome area is adequate . This judgement has been made using available evidence including a visit to this service. The health and personal care needs for people who use the service are set out in an individual plan of care and these plans are reviewed. Service users healthcare needs are not always met in full and the dignity of people who use the service has not always been respected in recent months. Medication management was not assessed on this occasion. EVIDENCE: Care plans were in place and three were examined. In all three there was sufficient information about the residents care needs. Moving and Handling risk assessments were in place and the plans had been evaluated. Nutritional risk assessments and Waterlow scoring had been undertaken. The incidence of pressure sores on the day of the visit was nil. The person in charge stated, “I do check residents weight regularly” and there was evidence in place to support this. Grosvenor House Nursing Home DS0000004111.V355297.R01.S.doc Version 5.2 Page 12 There was also evidence that residents had access to other health professionals e.g. GP and Chiropody. The plans also contain a life history of the resident. We were informed that all the residents have been offered the opportunity to obtain vaccination against influenza. For one person whose care plan was examined (Resident 1) her needs appeared to be changing quite rapidly (she did not appear to be well on the day of the visit, she appeared very frail and she had a number of marks and bruises up her arm). The person in charge stated, “I will be re-writing the care plan to reflect these changes”. The plan made reference to a recent skin tear she had sustained and a body map was in the care plan. There was evidence of monitoring of her weight however given that she spends all her time in her room it was not clear how staff actually monitor her food intake as she is at risk nutritionally. The person in charge stated, “I do know what residents eat – I work with the chef and see what food goes out to residents and I monitor this”. The care plan detailed some health issues, which had recently developed, and the records showed that GP’s instructions were being followed. There was also a record of communication with the relative’s however a property inventory sheet had not been completed. For another person whose care plan was examined (Resident 2) the care plan stated ‘Unable to maintain adequate nutrition’. Her weight had been recorded but again it was not clear how staff knew exactly how much she had eaten or drunk, as there were no records to show this. It was observed during a tour of the premises that a person (Resident 3) had a bruised face and a covered cut over her eyebrow. We were informed that this person had sustained a fall out of her bed but to fit cot sides to her bed was not a suitable option. It was suggested that a low bed might be a way to minimise and manage this risk in the future. The care plan contained sufficient information about health care needs. She is at high risk of pressure sores due to he skin condition and there here were no pressure sores documented. One resident was very upset and tearful, as staff had not fitted a sock over her catheter leg bag and the bulk of the bag was apparent through her dress. The person in charge immediately addressed this with staff. Grosvenor House Nursing Home DS0000004111.V355297.R01.S.doc Version 5.2 Page 13 Since the Random Inspection in May 2007 there have been a number of recorded incidents, which suggest a failure by the home to fully protect the people who live there. For example: In August 2007 a person from the home was admitted to hospital and unexplained bruising was noted. This was first noted on 24 July 2007 (extensive bruising). The outcomes to an investigation appear to be inconclusive and CSCI had not been informed of this bruising at that time. We have been reliably informed about some issues relating to people who live at the home indicating that their personal and healthcare needs had not always been fully attended to in order to promote their health, welfare and dignity .For example: 1.Falls out of bed 2.Unexplained bruises and cuts 3 Loss of weight 4.Some staff not respecting the privacy and dignity of people who live at the home 5.Missed hospital appointments Relatives offered the following comments: “It was bad. My mothers personal care was not attended to” “The home used to be good’. Anonymous information has been received by CSCI in relation to an alleged, uninvestigated incident of abuse. On the day of the inspection this information was not available at the home. See complaints and protection. Other comments included: “Grosvenor House is very good in most ways and XX is happy but her laundry could be improved. She is always losing her clothes”. A visitor to the home commented “I visit the home and I feel things are Ok for XX.There could be more staff on duty as XX has to wait to be attended to at times – sometimes for a considerable length of time”. “The staff at the home are excellent and the physical surroundings are very pleasant. Staff are friendly and caring to my mother”. “ I have no problems with the care of my mother – I am happy for her to be here – she is comfortable and well looked after”. Grosvenor House Nursing Home DS0000004111.V355297.R01.S.doc Version 5.2 Page 14 Given the inadequate bathing facilities for residents – it was not easy to ascertain when residents were offered a bath/shower etc. We were informed that this information is all contained in the daily records. However if this information was required, it is likely it would to take some time to collate it. It was evident on the day of the visit that supervision of residents was inadequate – both in the lounges and for those who chose to stay in their own rooms. A number of residents were thirsty and gladly took a drink when offered, by the person in charge, as we toured the home. It is of some concern that some residents may not be receiving adequate intake of fluid. This is likely to be a contributing factor for one resident who appears to have had a number of urine infections this year. There were indications that there have been some recent improvements to the care of people living at the home. Feedback from one relative indicated a recent improvement to her mothers care. “It is much better now –I am happy with the care, Julie and Jean have made a difference to my mothers care”. Grosvenor House Nursing Home DS0000004111.V355297.R01.S.doc Version 5.2 Page 15 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): Standards 12-15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people who use the home have some activities available however these are not always flexible and varied to suit their preferences and capabilities. A varied and appetising diet is provided and the home has a pleasant dining room. EVIDENCE: The home employs two activity co-ordinators. One is employed for 20 hours a week but has only very recently returned from sick leave, and one who is employed for 7 hours a week but has only recently been employed. Records of activities ceased in July 2007 and recommenced in November 2007.There was evidence from these records that some group activities had taken place but with only 6-7 residents participating. One relative commented, “They used to have good occupational therapy sessions – these have declined”. Grosvenor House Nursing Home DS0000004111.V355297.R01.S.doc Version 5.2 Page 16 Records did not show that residents who spent most of their time in their rooms were visited or supported socially. One resident who was in the main lounge stated, “I would love to read but I cannot see”. When it was suggested that perhaps talking books would benefit this person we were informed that these were ‘going to be accessed from the local library’. Records showed that some residents had the opportunity for manicuring and head massage. Individual profiles were in place for each resident and were mostly complete but given that the home has been without an activities coordinator for some months, it is likely these records may require updating. The residents had been out to lunch the day before this inspection. However it would appear that this trip was organised at short notice and relatives were perhaps not given sufficient time in order to properly prepare for this. The standard of meals provided by the home is good. An enthusiastic full time chef is employed and menus are available evidencing choices. The chef stated that he is aware of the food preferences and the ‘likes and dislikes’ of the people who use the service and this was evident following discussions with him. Feedback about the provision of meals by the home has been consistently good. Grosvenor House Nursing Home DS0000004111.V355297.R01.S.doc Version 5.2 Page 17 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Records are kept of complaints received and the home has a complaints policy in place. However records in the home did not show full investigations into complaints received or recorded outcomes. The service has polices in place in order to protect people from abuse however allegations of abuse are not consistent referred for a multi disciplinary investigation. EVIDENCE: The complaints logbook was examined. There had been some complaints logged and the most recent entry (29/10/07) was tracked. There were no recorded outcomes for this complaint and no investigation findings available at the home. We were informed that the area manager had in fact investigated this and that the paperwork was at head office. The logbook had not been completed with any outcomes of the investigation and it would appear that the complainant had not received a written response. Prior to this Inspection CSCI had received information detailed on a anonymous staff survey form. This related to an alleged abuse incident, which the staff member felt had not been investigated in full. This was explored at this inspection and no records could be found in relation to this. We were informed that all the paperwork relating to this incident had been sent to head office and it was requested that this information be forwarded to CSCI following this inspection. Grosvenor House Nursing Home DS0000004111.V355297.R01.S.doc Version 5.2 Page 18 This information has since been received by CSCI. A full investigation appears to have been carried out into this allegation however it is of some concern that given there is photographic evidence of bruising, that this was not referred to the Adult Protection Team for a multi disciplinary investigation. There is also a letter confirming this employee has been moved to another home to continue working as a carer. Information received from a concerned relative relating to an incident with her mother is likely to be connected to this carer also. The person in charge stated, “My first month was spent investigating complaints from staff and all the information went to head office. Staff were disregarding moving and handling and residents privacy and dignity was not being respected”. A carer answered the door to the home and invited the Inspector in without asking for her ID.This also occurred when the Inspector arrived to carry out the Random Inspection in May 2007. Grosvenor House Nursing Home DS0000004111.V355297.R01.S.doc Version 5.2 Page 19 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): Standards 19,21-26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The premises are not always safe and well maintained and air temperatures are not consistent throughout the home. Bathing facilities do not meet in full the needs of the people who use the service. Individual rooms are personalised and furniture is provided. The standards of cleanliness had improved since the Random Inspection in May 2007. EVIDENCE: A new key coded lock had been fitted to the front door. A gardener has been employed and has made improvements to the outside garden area. In the ground floor dining room a new non-slip laminate floor had been fitted and this room was clean and bright. Picturesque artwork was evident in the communal areas. Grosvenor House Nursing Home DS0000004111.V355297.R01.S.doc Version 5.2 Page 20 Overall there had been improvements made to the homes standard of cleanliness from the findings of the last inspection. Some furniture was shabby and worn but we were informed that some furniture had been replaced and there are plans to replace more furniture. The person in charge stated, “All the furniture is going to be replaced in the main lounge”. Paintwork in the main lounge was scuffed and chipped in places. The individual rooms seen were all personalised and generally clean however on closer inspection attention to detail was lacking for example there were cobwebs around one window in a resident’s room. It is likely that other areas are equally neglected given that the home has only recently employed a domestic after a period of time without this ancillary support. There were some health and safety matters identified on the day of the visit; 1.The conservatory on the ground floor was cool .We were informed that the heating is not efficient in this area and this has ‘always been a problem’. Air temperatures throughout the home fluctuated and comments received from staff indicted that the home was “hot at night”. It was suggested the home monitors the air temperatures regularly and records be kept. 2.Given that there is open access to the road and surrounding area it would be beneficial if window restrictors were fitted to the windows in the conservatory as people who live at the home may be at risk of intruders. 3.The fire exit door leading from the conservatory was hard to open and would present a hazard in an emergency. An Immediate Requirement was left on the day of the visit to address this matter without delay. There were some areas in the home, which were odourous. For example: 1.The sluice 2.The ensuite toilet facility in one person’s room 3.The main bathroom on the ground floor. This room was also very hot on the day of the inspection. Some of the ventilation fans sited in these rooms did not appear to be functioning well and is a likely explanation for the odour. In one person’s ensuite bathroom the ventilation fan was not working at all. Grosvenor House Nursing Home DS0000004111.V355297.R01.S.doc Version 5.2 Page 21 The home still does not have a sluicing disinfector installed. This has been an ongoing requirement from previous inspections. We were informed at this inspection that one is going to be installed in January 2008. There was also a leak noted on the floor of the sluice room. An Immediate Requirement was left on the day to address this matter. We were informed that a Maintenance Person is employed for three 3 days a week and a log is made by staff of any maintenance work required. The maintenance person does not detail actions taken to address these issues so it was difficult to know if any action had in fact been taken. We were informed that it is likely these ‘jobs’ had been completed but it was agreed with the person in charge that he needs to ‘sign these jobs off and date’ when completed. The general lack of adapted bathing facilities was apparent throughout the home. This has been identified on previous inspections. There are five rooms on the ground floor with ‘luxury’ ensuite facilities. We were informed that the showers in these ensuites would only be suitable for a person who is fully mobile and not if a person has a physical disability or restricted mobility. The person in charge stated “All five showers in these ensuites are being changed to wet rooms”. On this floor there is also an additional bathroom, which is not fit for use if a hoist was required to be used. The one adapted bathroom in use on the ground floor was very hot and odorous. The ventilation fan did not appear to be working effectively. On the first floor there is a shower room. It is a small room with dim lighting and the shower bracket had broken. The light switch was positioned behind the door and appeared quite difficult to access. We were informed that the lighting in this room does eventually ‘brighten up’. The home has three shared rooms, which have ensuite facilities (baths). We were informed that these baths would not be suitable for a person who may have a disability or restricted mobility. The laundry facilities appear to be satisfactory. Individual baskets are provided for resident’s laundry and the home takes responsibility for marking clothes, underwear etc. A new tumble drier has been fitted however this leaves a gap in the floor covering which requires attention. One person is employed to work in the laundry in the mornings and care staff also do washing overnight. It was noted that in the shared rooms visited ‘hospital type’ portable screens are provided but these are not suitable for a home environment and may not provide full privacy when personal care is being delivered. Grosvenor House Nursing Home DS0000004111.V355297.R01.S.doc Version 5.2 Page 22 In one room the bed head was positioned directly by a radiator and this would undoubtedly be hot overnight. It was suggested that the bed could be repositioned to a more appropriate place, with the agreement of the person who lives in that room. We were informed that there are plans to fit new floors to the sluices and staff toilet. Grosvenor House Nursing Home DS0000004111.V355297.R01.S.doc Version 5.2 Page 23 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): Standards 27,29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing numbers are not always appropriate in order to meet the needs of the people who use the service. Staff receive training appropriate to their roles but do not always receive a full and comprehensive induction. Staff files do not contain all the required information however CRB checks had been carried out and references taken up. EVIDENCE: There was evidence of staff training and certificates were seen on file for mandatory training provided by the organisation. Staff spoken to had received training appropriate to their roles. One trained nurse stated, “I have had training in Fire safety, Infection Control, Moving and Handling, Food Hygiene, Diabetes, Tissue Viability, Nutrition, Falls management and elder abuse. The person in charge stated, “The training is good here”. Two staff files were examined. Some records were missing from these files and did not appear to be available for inspection. Grosvenor House Nursing Home DS0000004111.V355297.R01.S.doc Version 5.2 Page 24 In particular: Application forms and health declarations Proof of identity Full employment history. On one file there was a POVA 1st check in place but no reference to a full CRB, and in another file a full CRB disclosure was in place. CRB record keeping appears to be inconsistent and in order to comply with CRB guidelines the organisation must ensure that ‘Disclosure information is be kept securely. ………………………with access strictly controlled and limited to those who are entitled to see it as part of their duties’. It was not clear on the reference forms on whose behalf the references were being given e.g. Company/hospital name etc. It is suggested that the forms be reviewed by the organisation. There was a record on file relating to one of the homes ancillary staff that had recently been employed by the home. This record was in the form of a letter/statement written by another member of the homes staff. The details related to an incident when this person had got a resident out of bed on her own and had not called for assistance from a carer. There was no record of a full investigation with statements taken; the letter inferred that this person had been verbally told not to do this again. This person had not had an induction and had not worked in a care home setting before. It may be likely that the resident wanted to get out of bed but there were no other staff available to assist. There was also another alleged incident involving this person and a member of staff. The person in charge appears to have been informed but it was unclear as to what action had been taken to address this. Feedback from staff indicated that some had received an induction others had not or it had only been for one day. We were informed that the induction is inadequate, only lasting for one day and then new staff are ‘on rota’. We were also informed that this is likely to be changed in January and the induction will be more comprehensive. The file examined for one new member of staff did not contain a record of her induction. We were informed that these records were at ‘head office’. This record of induction has since been received by CSCI and all aspects of her induction appear to be delivered in one day. Grosvenor House Nursing Home DS0000004111.V355297.R01.S.doc Version 5.2 Page 25 One carer stated “I did not have an induction when I started here”. The new domestic had not had any form of induction. One of the trained nurses stated ““I did my adaptation here and I am a Trained nurse in India”. I have just got my PIN. I did have an induction and it was enough for me”. Whilst touring the premises it became apparent that there was a lack of supervision of residents in both lounges. For example in the main lounge two residents required attention, one to the position in her chair and the other to her personal care needs but there were no staff around to administer this care. There were some residents in their rooms and during a tour of the premises one resident was visited in her room. She appeared to be thirsty and when offered, took a drink from the person in charge. One resident was sitting at the dining table well after breakfast had finished. It appeared that she was waiting for a carer to take her to the lounge or to her room. We were informed that there had been a change in the hour’s staff work, which may be impacting on the residents. The evening shift now finishes at 20.00 and not 21.30.There seems to be some misunderstanding between night staff and day staff as to what happens in the one and a half hours extra the night staff have to work. Staff informed us that the night staff would prefer it that some residents are put to bed earlier. We were informed that the change in rota is to fall in line with the other homes. This change appears to have impacted at lunchtime and residents are sometimes left at the table for longer periods. The evening routine is also affected with staff leaving at 8pm. It appears that this conflict/misunderstanding had not been addressed however the person in charge informed us that at the staff meeting that evening, which she was chairing this matter was to be discussed. Grosvenor House Nursing Home DS0000004111.V355297.R01.S.doc Version 5.2 Page 26 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): Standards 31,32,36-38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is no Registered Manager in post and the interim arrangements for the day-to-day management of the home are unsatisfactory. However there are indications that some recent improvements have been made to the standards of care and cleanliness at the home. The home has a Quality Assurance process however it is not being consistently applied in order to ensure people’s voices are fully heard. Staff are being supervised and appraised. The health and safety of people who live and work at the service is mostly protected. Some records pertaining to staff and people who use the service were not available for inspection The management of money for people who live at the home was not assessed on this occasion. Grosvenor House Nursing Home DS0000004111.V355297.R01.S.doc Version 5.2 Page 27 EVIDENCE: We were informed that the person in charge (Manager designate) currently only has two days supernumery time in order to carry out management tasks. She did inform us that “Last week I worked on shift for 6 days. I do not have the time to address all the matters, which need to be addressed”. There is no Deputy Manager in post to provide additional management support. There are indications that some recent improvements have been made to the quality of care at the home however the lack of management time allocated to the person in charge is limiting the full improvement of the service. The person in charge moved to the home in early August and the AQAA is dated 10 August 2007. Given also that some records were not available for inspection on the day of the visit it is not clear how this document could have been completed accurately in order to reflect current standards at the home. There was evidence of some staff supervision being undertaken. Staff commented:“I had an appraisal last month with Jean” “I have had supervision with Jean - this was part of my adaptation”. Feedback from the staff survey indicated that some staff were not yet receiving regular supervision. With the time constraints placed on the person in charge it is likely that there is no structured programme of supervision implemented as yet. A staff meeting had been arranged for the evening of the inspection and staff were seen to attend. One trained nurse stated, “There was a staff meeting in August but I could not attend”. Maintenance records were requested to be forwarded to CSCI and have been received. Records are in place to evidence the internal routine maintenance of: Cot sides, Nurse call system, Fire alarms, Wheelchair safety, Hoisting equipment, Emergency Lighting and Fire equipment. Records show there was a recent fire drill in September 2007 and all staff on duty were noted to have attended. Grosvenor House Nursing Home DS0000004111.V355297.R01.S.doc Version 5.2 Page 28 External contracts were in place to evidence the regularly safety checking and maintenance of Hoists/passenger lift, Legionella testing and water chlorination to include the cleansing of shower heads, Environmental Health Inspection, Clinical waste contract, Gas safety and Fire equipment Records show rooms where the water temperatures are above 41C. In June 2007 an external contractor identified hot water in a number of rooms and detailed that valves needed to be fitted to regulate the water temperatures. On the 10 December it is recorded that these valves had been fitted A fire risk assessment had been carried out in May 2007. From the records, there appears to be some outstanding matters to be addressed. Records show that one piece of work only has been actioned. This must be addressed without delay. An external contractor stated in a report following an inspection of the Fire and Intruder alarms ‘the detectors in room 7 and corridor outside room 10 failed to respond to ‘coldsmoke’. It is not clear from the records if this work has been carried out. This must be addressed. There is a record of fire training in November 2007 and 13 staff attended. Internal audits are carried out and the company employs an Area Manager for ‘Systems and Procedures’, who was present at the home for part of this inspection. We were shown some surveys sent out people who live at the home and/or their relatives. These did not appear to be recent ones. It was not clear if these had been assessed and actions taken as a result of comments made. For example in one survey “I would like a grab handle in the toilet”. We were informed that there had not been a recent ‘customer satisfaction’ survey sent out. Grosvenor House Nursing Home DS0000004111.V355297.R01.S.doc Version 5.2 Page 29 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 3 x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 x 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 2 x 1 x 3 3 2 2 STAFFING Standard No Score 27 2 28 x 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 2 2 x x 3 2 2 Grosvenor House Nursing Home DS0000004111.V355297.R01.S.doc Version 5.2 Page 30 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 OP12 Regulation 16(2)(n) Requirement Timescale for action 06/12/07 2 OP19 23(2)(d) 3 OP27 18(1)(a) All the people living in the home must after consultation be provided with activities in relation to recreation and exercise to enable them to continue enjoying their individual hobbies and interests. (This requirement was assessed as part of this inspection. The previous timescale of 24/06/07 remains. The date given is the date of this inspection) The home must review the 06/12/07 condition of the décor & carpets in the home to ensure that people living in the home are not placed at risk of cross infection and that the environment looks nice. (This requirement was partly assessed as part of this inspection. The previous timescale of 24/06/07 remains. The date given is the date of this inspection) The home must ensure that the 18/01/08 care and social needs of the people living at the home are met by reviewing the adequacy of the staffing levels particularly DS0000004111.V355297.R01.S.doc Version 5.2 Grosvenor House Nursing Home Page 31 during peak times of the day. 4 OP31 The registered provider shall appoint an individual to manage the care home where – there is no registered manager in respect of the care home and the registered provider is not, or does not intend to be, in full time day-to-day charge of the care home. The registered provider shall give notice to the commission of the name of the person appointed and the date on which the appointment is to take effect. 23(2)(p) The home must ensure adequate ventilation is provided in all parts of the home which are used by the people who live there. This will ensure any unnecessary odours are eliminated. 18(1)(c) The home must ensure that all (i) new staff receive a robust induction, in line with Skills for Care, before working alone with people at the home. This will ensure staff are competent to do their jobs. 23(2)(j) The Registered Person must ensure that sufficient, adapted and appropriate bathing facilities are provided at the home. This will ensure that people who live at the home are able to take a bath or shower when needed or wanted. 23(2)(b) The Registered Person must ensure the premises are kept in a good state of repair at all times. 13(4)(a-c) The home must ensure that any 23(2)(b,c) outstanding work required Fire regs following recommendations from external contractors is actioned. This will ensure the ongoing safety of the people who live at DS0000004111.V355297.R01.S.doc 8(1)(a) 8 (b)(iii) 8(2)(a,b) 28/02/08 5 OP38 31/03/08 6 OP30 28/02/08 7 OP21 30/04/08 8 OP19 28/02/08 9 OP19 OP38 28/02/08 Grosvenor House Nursing Home Version 5.2 Page 32 the home. In particular: - Outstanding work following a fire risk assessment carried out in May 2007 - Following an inspection of the Fire and Intruder alarms ‘the detectors in room 7 and corridor outside room 10 failed to respond to ‘cold smoke’. 10 OP37 17(3)(b) The home must ensure that records and documents relating to the running of the care home are at all times available for inspection at the care home by any person authorised by the commission to enter and inspect the care home. 31/01/08 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 OP14 Good Practice Recommendations Residents should be given the choice of having a bath more than once a week to enable them to exercise choice over their personal hygiene needs. (This recommendation is carried forward form the last inspection). Given that there is open access to the road and surrounding area it would be beneficial if window restrictors were fitted to the windows in the conservatory. The home should consistently operate a staff disciplinary procedure, where necessary, in the interests of the people who live at the home. It is suggested that the staff reference forms be reviewed by the organisation. The home should have systems in place to ensure all allegations of abuse are referred for a multi disciplinary investigation to ensure proper practice in the future. It would be beneficial if a qualified first-aider were on duty at all times. The screening in the shared bedrooms must be reviewed to ensure that the privacy & dignity of the residents is DS0000004111.V355297.R01.S.doc Version 5.2 Page 33 2 3 4 5 6 7 OP38 OP27 OP29 OP18 OP38 OP10 Grosvenor House Nursing Home 6 OP38 maintained at all times. It is suggested the home monitors the air temperatures regularly and records be kept. This will ensure a comfortable environment for the people who live at the home and for staff who work there. Grosvenor House Nursing Home DS0000004111.V355297.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection 3rd Floor 77 Paradise Circus Queensway Birmingham B1 2DT National Enquiry Line: 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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