Inspection on 23/05/05 for Grosvenor Lodge

This inspection was carried out on 23rd May 2005.

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 Lodge 28/09/07

Grosvenor Lodge 30/05/06

Grosvenor Lodge 18/10/05

Grosvenor Lodge 03/02/05

Grosvenor Lodge 28/09/04

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

CARE HOMES FOR OLDER PEOPLE Grosvenor Lodge 40 Old Shoreham Road Hove East Sussex BN3 6GA Lead Inspector Jane Jewell Unannounced 23 May 2005 10:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Grosvenor Lodge H59-H10 s14201 Grosvenor Lodge v220087 230505 stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service Grosvenor Lodge Address 40 Old Shoreham Road Hove East Sussex BN3 6GA 01273 739739 01273 739739 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs M Holliday-Welch Mrs Kim Long Care Home 31 Category(ies) of Dementia (31) registration, with number of places Grosvenor Lodge H59-H10 s14201 Grosvenor Lodge v220087 230505 stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: 1) The maximum number of service users to be accommodated is thirty-one (31). 2) Service users must be older people aged sixty-five (65) years or over on admission. 3) Service users with a dementia type illness only to be accommodated. Date of last inspection 3rd February 2005 Brief Description of the Service: Grosvenor Lodge is a privately owned residential home for up to thirty-one older people who have dementia. The home’s provider also owns a further four registered homes for older people within the Sussex area with each home being a standalone business. The home is a large detached property situated in Hove on the main A270. It is located near to local amenities such as shops, cafes and bus routes into Brighton and Hove. The home is presented across four levels, basement, ground, first and second floor with access to the first floor and second floors via stairs or shaft lifts. Resident’s accommodation consists of twenty-seven single and two shared bedrooms, with all rooms providing en-suite facilities. Shared facilities include two lounges, dining room, hairdressing room, conservatory and rear garden. The front garden is mainly paved to provide off road parking. The homes literature states that the home is committed to offer a highly professional care service for the elderly with a personal touch. Grosvenor Lodge H59-H10 s14201 Grosvenor Lodge v220087 230505 stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced routine inspection, which was undertaken by two regulation inspectors between 10.20am to 3.30pm. On the day of the inspection there were twenty-seven residents living at the home. The inspection involved a tour of the premises, examination of the home’s records, discussion with management, consultation with five staff on duty and fifteen residents. Much of the inspection was spent observing residents living at the home. In order that a balanced and thorough view of the home is obtained, this inspection report should to be read in conjunction with the previous inspection reports. The Inspectors would like to thank the residents, staff and management for their assistance during the inspection. What the service does well: What has improved since the last inspection? The manager had addressed the vast majority of requirements made during previous inspections and is making significant progress to address those areas that remain outstanding. This has improved practices at the home and the quality of life for those living there. Grosvenor Lodge H59-H10 s14201 Grosvenor Lodge v220087 230505 stage 4.doc Version 1.20 Page 6 Opportunities for occupation and stimulation have improved and now include a range of activities for residents to choose to become involved in. A clearer sense of management direction and leadership is more apparent with the introduction of staff appraisals, clearer administrative systems and improved working practices at the home. The home is still undergoing a refurbishment programme and the investment made to date continues to improve the environment for those living at the home. What they could do better: Recruitment practices need further tightening to ensure that police checks are undertaken on all staff, in order to safeguard residents. The homes management of risk must be improved to ensure that residents are not placed at undue risk from infection, fire safety and accidental ingestion of hazardous cleaning chemicals. As far as is practicable residents must be able to make decisions in respect of the care they are to receive and regarding their health and welfare. An action plan was provided by the registered provider, which detailed the actions being undertaken to address the shortfalls in practices noted during this inspection. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Grosvenor Lodge H59-H10 s14201 Grosvenor Lodge v220087 230505 stage 4.doc Version 1.20 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Grosvenor Lodge H59-H10 s14201 Grosvenor Lodge v220087 230505 stage 4.doc Version 1.20 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,3 and 4 There is a good standard of information about the homes services and facilities to help inform and guide both prospective and current residents. Residents are only accommodated following an assessment of their needs by the home. EVIDENCE: A statement of purpose and service user guide sets out the homes aims, objectives, facilities and the terms and conditions of the home. Both these documents are made available to residents and other interested parties and is displayed within the home. The style of these documents means that they are easy to read and can be adapted into large print if needed. Copies of previous inspection reports are available upon request. Assessment documentation was examined for a recent admission. This showed that the manager had undertaken a needs assessment prior to admission and had obtained copies of social care needs assessment. Assessments undertaken by the manager are either carried out while the prospective resident is visiting the home or at their current address. Advice is also sought during the assessment process from professionals and others who know and understand the needs of prospective residents. The information gathered enables the Grosvenor Lodge H59-H10 s14201 Grosvenor Lodge v220087 230505 stage 4.doc Version 1.20 Page 9 manager to make an informed decision as to whether needs could be met at the home. Residents spoke of a quiet and contented life at the home, which suited their individual lifestyles and expectations. Residents appeared relaxed and comfortable in their surroundings. Residents have a high level of personal care needs with some residents having physical needs in addition to Dementia. The home is able to provide evidence that most needs of residents are able to be met, however some needs identified at inspection were not being addressed satisfactorily and include manual handling and accessing bedrooms during the day. These issues are explained further on in this report. Grosvenor Lodge H59-H10 s14201 Grosvenor Lodge v220087 230505 stage 4.doc Version 1.20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9 and10 Care plans seen provided a good framework for the delivery of care, however further work is needed to ensure that these include clear guidance on the management of manual handling. The health needs of residents are well met with evidence of good multi disciplinary working taking place on a regular basis. The system for the administration of medication remains good with clear and comprehensive arrangement being in place to ensure resident’s medication needs are met. EVIDENCE: Care plans are made up of many documents including assessments, plan of care, monthly reviews, and nutritional assessments. Good practices were noted in the use of personal histories, which enable staff to be aware of significant events and individual lifestyles prior to the onset of dementia. Of the sample care plans seen these provided good guidance for staff on most needs of residents, however further work is needed to ensure that residents or their representative evidence that they are aware of its contents. The standard of daily recording remains good with a clear account of actions and events that had occurred. The style of the care planning documentation means they are easy to navigate and are user friendly. Grosvenor Lodge H59-H10 s14201 Grosvenor Lodge v220087 230505 stage 4.doc Version 1.20 Page 11 Individual core risk assessments have been undertaken including manual handling assessments. However these did not always reflect the safe handling techniques to be used by staff to safely move particular residents. Staff were observed using a moving technique that is not consistent with good practice. This was a concern noted during the previous inspections and to address this the area manager had tried to obtain further guidance on making the risk assessments clearer to staff. As a matter of priority the manager is required to make suitable arrangements to provide a safe system for the moving and handling of residents. The home does not provide nursing care. Residents are registered with a variety of local GP’s and where possible residents are enabled to retain their GP prior to moving to the home. Where there have been concerns around a resident’s health medical intervention had been sought promptly. Examples were also noted whereby additional support and guidance had been obtained from health care professionals when concerns had been raised regarding the changing or emerging needs of residents. A record of residents weight is maintained which enables the manager to monitor any patterns of weight loss or gain. Community nurses advise on all aspects of treatment and prevention of tissue breakdown. Additional health care needs are assessed and dealt with by opticians, dentist, chiropodist and community psychiatric nurses. Since the previous inspection the home has been working closely with continence advisers to implement a new system of continence aids. None of the residents accommodated are assessed as safe to administer their own medication. The home has medication policies and a senior carer who is in charge of the medication has commenced a ‘ safe handling of medication course’ at a local college. All medications were stored correctly and had been signed for once administered. The clinic room was very clean and tidy and had adequate storage for all medication. Resident’s appearance was presented in a manner that preserved their dignity, namely appropriately clothing for weather conditions, which were laundered to a good standard and regular hairdressing input. Residents felt they are treated with respect and their right to privacy is upheld. Grosvenor Lodge H59-H10 s14201 Grosvenor Lodge v220087 230505 stage 4.doc Version 1.20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14 and15 Residents are provided with a good range of opportunities for occupation and stimulation. Visitors are made to feel welcome. Some flexibility is provided in the routines of daily living. Further work is still needed to ensure that resident’s autonomy and choices are respected. Meals provided are plentiful with residents speaking positively about the food provided. EVIDENCE: Since the previous inspection opportunities for occupation and stimulation have increased with a good range of activities being provided for residents, including Karaoke, bingo, reminiscence, board games, art therapy, extend classes and a piano player. Residents are encouraged to join in these activities, which are largely provided by the care assistants. Residents consulted identified that staff are kind and that they have enough activities. In order to promote consistency, orientation and awareness there is a need to provide a programme of activities, to enable residents, visitors and staff to be aware of planned activities. The home has a cat, and residents were observed enjoying talking about it and petting it. The home provides communal space for residents to meet visitors and bedrooms are used to meet visitors in private. Relatives spoken to prior to the inspection stated that they are able to visit the home at any reasonable time and were kept informed and consulted about the care of their relative. Grosvenor Lodge H59-H10 s14201 Grosvenor Lodge v220087 230505 stage 4.doc Version 1.20 Page 13 During the inspection some residents were observed to move around the ground floor freely, choosing which room to be in and what level of company they wanted to enjoy. During the day most residents do not access their bedrooms on the first/second floor unless able to so independently as due to the level of confusion most do not have the capacity to use the lift independently and therefore rely on staff. The home was previously required to ensure that residents are able to make decisions with respect to the care they are to receive and their health and welfare. Although this had partially been addressed further work is still needed to ensure that the individual needs of each resident as to whether they need or would like to have the opportunity to use their bedroom during the day. For example for a nap, lay down or some quiet time be recorded so that staff aware of individual needs. Care must be taken that residents are not seen to be restrained in the reclining chair, which they are unable to get out of independently, if able. The use of the reclining chair must be supported by a consent form and risk assessment. The manager and area manager reported that they have addressed previous concerns of some routines of daily living not always being determined by residents, namely in rising and going to bed. This had been discussed at staff meetings and they assured the inspectors that staff are instructed to determine the wishes of residents prior to assisting them to get up or go to bed. Residents who were able to share their wishes with the inspectors confirmed that they could get up and go to bed when they wish. It could not be clearly established whether residents who are unable to verbally communicate, whether their wishes in rising and going to bed are always respected and will remain a focus at future inspections. The Kitchen was well-equipped and provided suitable facilities for catering. It was seen to be clean and well organised. A new cook has recently been employed and was undertaking their induction into the home. They worked for many years in commercial catering and this was their first experience working with people who have dementia. It was recommended that for the future specialist training should be obtained for them on catering for people who have dementia. Their food hygiene certificate had expired and there was a need for this to be renewed. Staff were observed entering the kitchen on many occasion not wearing appropriate protective clothing, in line with good practices in infection control. The day’s menu is displayed in the dinning room including the alternative options to the main menu. Records of meals provided showed that the vast majority of residents have the main meal offered. The cook was not yet aware of the need to record all meals provided including any alternatives, therefore it was not clear the level of choices being made by residents. In addition to the main meals, snacks and drinks are available at various times throughout the day. The meal offered on the day of the inspection was plentiful and presented well. Liquidised meals are presented in a manner, which is attractive, and Grosvenor Lodge H59-H10 s14201 Grosvenor Lodge v220087 230505 stage 4.doc Version 1.20 Page 14 appealing in terms of texture, flavour and appearance. Residents stated that they enjoyed the meal and that the food was generally very nice. The dinning room is arranged to promote a social atmosphere and is decorated and set to a good standard. Residents who require support to eat were seated in a smaller dinning area. This was reported to help preserve their dignity. One care assistant was seen to be feeding two residents at once, although it was stated that this did not usually happen and was due to a member of staff being called away. One resident was observed to be struggling to use conventional cutlery and it was recommended that the manager establish whether they would benefit from specialist equipment to help maintain their independence. The mealtime was observed to be relaxed and unrushed. One resident repeatedly get up throughout their meal and staff heated their meal to ensure it remained palatable. Grosvenor Lodge H59-H10 s14201 Grosvenor Lodge v220087 230505 stage 4.doc Version 1.20 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 There is a formal complaints procedure in place. Adult protection procedures are in place and ongoing training provided, however not all of the homes practices safeguard residents from potential abuse. EVIDENCE: The home has a complaints procedure in place for residents, their representative and staff to follow should they be unhappy with any aspect of the service. Complainants are invited to log a complaint either verbally with the manager or through the completion of a complaints log. There were no complaints reported or recorded in the home’s documentation since the last inspection. The Inspectors was assured that if complaints were received then the requirements of the standard and the homes policy would be followed. None of the residents consulted had expressed any concerns or complaints. The majority of those consulted said that they would let their relative know that they were unhappy who would then speak to the manager about it. One relative spoke to the inspector prior to the inspection to raise some issues regarding the environment. These were passed onto the manager who had addressed all of the points raised. A copy of the East Sussex Multi Agency guidelines on the Protection of Vulnerable Adults is available for the manager to reference. There are policies on adult protection, which defines abuse, identifies different types of abuse, reporting procedures and potential signs of abuse. The home has a ‘no gifts’ policy along with policies on the management of aggression and challenging behaviour. Grosvenor Lodge H59-H10 s14201 Grosvenor Lodge v220087 230505 stage 4.doc Version 1.20 Page 16 Some staff have undergone training in adult protection and it was reported that further training is due shortly. Staff showed an understanding of their responsibilities to report any concerns. It was reported during previous inspections that the manager would be undergoing the required adult protection training following the last inspection this had not yet been undertaken. In view of the high level of support needs of residents efforts are made to protect them from leaving the home unescorted, including a keypad entry and exit system to the home. Procedures have been developed for staff to follow should a resident be unaccounted for. Not all of the homes practices currently safeguard residents. This includes: • Police checks were not undertaken for staff doing trial shifts at the home. • As previously noted the use of a reclining chair which residents were unable to independently get out of was in use without written consent or a risk assessment having been undertaken. • As previously noted not all of the moving and handling techniques recorded and observed reflected safe handling guidelines. Grosvenor Lodge H59-H10 s14201 Grosvenor Lodge v220087 230505 stage 4.doc Version 1.20 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,22,24,25 and 26 Investment has significantly improved the appearance of the home creating a comfortable environment for those living and visiting. Standards of cleanliness were variable on this occasion with some practices not promoting good infection control standards. EVIDENCE: The Home is well located in relation to the local community, community services and transport links to Brighton and Hove. A major refurbishment programme is near completion, which has included the redecoration of all bedrooms, communal areas and the building of a large conservatory. In addition new furniture and fittings have been purchased which have a domestic feel and are of a high quality. It is recognised that where redecoration and refurbishment has been undertaken then this has been to a high standard and much commitment and expense has been invested towards improving the environmental standards. Areas that are still due to undergo refurbishment include the replacement of ensuite baths and toilets, and bedroom doors. A comprehensive maintenance schedule is kept constantly updated by the regional manager. Grosvenor Lodge H59-H10 s14201 Grosvenor Lodge v220087 230505 stage 4.doc Version 1.20 Page 18 Communal space consists of two lounges, dinning area, hairdressing room, foyer area and large conservatory, all of which are decorated and furnished to a good standard. There is a secure rear garden, which is reached via a ramp from the conservatory. Due to the level of building works currently being completed some equipment had been stored in the garden and the flower beds and grass were in need of maintaining to make it an attractive area for residents to use. The manager reported that the homes gardener was due to visit in the near future. The home is on three floors and the top floor contains some rooms that are accessible by small flights of stairs. One of these rooms which is not being used at present has areas of damp and it was advised that the door to this room be kept shut until the repair work is finished. This is to avoid other residents entering into it and prevent the smell of damp from spreading into the corridor. Resident’s rooms are pleasant and have a lot of natural light. Most floor coverings are linoleum in order to aid the cleaning. Some of the rooms do not have a lockable drawer, and it was reported by the manager that new lockable bedside cabinets are gradually being purchased. It was noted that in one shared room a chest of drawers had labels to indicate which resident the drawers belonged to. It is recommended that this be reviewed to prevent an institutionalised feel to the room. There are two toilets on the ground floor, which are accessed through the dinning room and along a corridor. With the vast majority of residents spending the day downstairs it is these toilets that are used predominantly and residents often had to wait to use them. An additional toilet is currently in the process of being built along with an additional shower on the ground floor. Standards of cleanliness were variable with communal areas cleaned to a good standard but some bathrooms standard of cleanliness was poor, this includes soap dishes and sinks were not clean. When bedroom floors are swept the contents are swept into the hallway for hovering once all the bedrooms are cleaned on that floor. This resulted in hallways looking untidy and the sweepings being walked through leading to some minor marking on hallway carpets. It is recommended that this practice be reviewed. A laundry assistant is employed and clothes were noted to have been laundered to a good standard. Previous issues relating to overflow pipes from the laundry had been promptly addressed. Although there are policies and procedures on the management of infection control and communicable diseases not all of the homes practices promoted good infection controls standards. These include: • Tooth mugs in double rooms were seen to contain two sets of brushes. • The need to re-seal around some wash hand basins. Grosvenor Lodge H59-H10 s14201 Grosvenor Lodge v220087 230505 stage 4.doc Version 1.20 Page 19 • • • Protective clothing not being worn by staff when entering the kitchen area. The need to use red alginate bags for soiled laundry. Hand towels need to be made available in all communal toilets. Grosvenor Lodge H59-H10 s14201 Grosvenor Lodge v220087 230505 stage 4.doc Version 1.20 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29 and 30 There continues to be sufficient numbers of staff on duty to meet needs of resident’s. Much commitment is shown towards providing training and development opportunities for staff. Generally recruitment documentation is thorough, however, police checks had not been undertaken for a new staff member. EVIDENCE: On the day of inspection there were four care assistants on duty plus two domestics, a laundry assistant, a cook and the manager. The rota indicates that it is normal to have five care assistants on duty however, one member of staff had phoned in sick prior to the shift commencing. Two care assistants and one senior carer is on night duty. Staff felt that there was sufficient staff on duty to ensure that the needs of residents could be met. Residents felt that whenever they needed assistance there was enough staff available to help them. The deployment of staff is mainly based on a key working system, whereby a named person undertakes the personal care tasks for a resident. This is to promote the continuity of care practices. The interaction between staff and residents was relaxed and friendly. Four residents spoke of a particular favourite members of staff who they looked forward to seeing and spending some individual time with. Other residents were observed enjoying some playful banter with staff. The staff complement is reflective of a multi- cultural society and the team reflects the gender composition of residents. Grosvenor Lodge H59-H10 s14201 Grosvenor Lodge v220087 230505 stage 4.doc Version 1.20 Page 21 In the absence of the manager supervisors undertake the responsibility for the home. The manager was previously required to ensure that they are suitably qualified to do so. All supervisors and senior carers were due to commence NVQ level 3 training following the previous inspection, however due to funding issues by the training organisation this has been delayed. Documentation was seen for newly recruited staff, this included a comprehensive application form, two written references, copies of qualifications and proof of identity as well as a competency assessment. In order to establish the suitability of prospective staff they undertake trial shifts and are assessed during the shift. However, a police check had not been undertaken prior to them commencing these shifts and the manager was asked to address this immediately in order to safeguard residents. Much commitment is shown towards obtaining NVQ training for staff. An NVQ training plan has been developed to ensure that the vast majority of staff have an opportunity to undertake such training. Training undertaken since the last inspection includes bereavement, manual handling, TOPSS induction and medication. Training planned for the near future includes adult protection, fire safety, Alzheimer’s and refresher courses in manual handling. Training needs identified during this inspection included for all staff to undertake infection control training and for all domestic staff to receive COSHH training. The staff group includes a core group who have worked at the home for many years. Their experiences, together with training indicates that they have a suitable level of competence and make a positive contribution to the quality of life of residents. Grosvenor Lodge H59-H10 s14201 Grosvenor Lodge v220087 230505 stage 4.doc Version 1.20 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,33,36,37 and 38 The manager has many years experience in working at the home and continues to improve their working knowledge of legislation and good practices in the care of people with dementia. Internal systems are in place to monitor the quality of the services provided of the home. Although there are some examples of good health and safety practices improvements must to be made to the management of risks associated with hazardous cleaning chemicals and fire safety. EVIDENCE: The manager has been in post since 2001, prior to this they worked at the home for many years. They are currently undertaking an NVQ level 4, which they reported have been their main training focus. Upon its completion discussion occurred on the opportunity to be able to undergo more specialist training in order to keep up to date with best care practices in dementia care Grosvenor Lodge H59-H10 s14201 Grosvenor Lodge v220087 230505 stage 4.doc Version 1.20 Page 23 The manager was open and helpful in their discussions with the inspector and staff spoke positively about their management approach. Residents were relaxed around the manager and spoke affectionately about her. The Inspectors continue to recognise the progress made in improving standards within the home and the significant progress made by the manager towards improving their working knowledge of the National Minimum Standards. Regular recorded visits by the regional manager have been implemented. These have been recorded to a high standard. Information from feedback questionnaires on the quality of the services provided have been compiled by the regional manager into a report. This indicates that the majority of people were pleased with the quality of the services at the home. In addition the manager and regional manager have recently undertaken spot checks on the home outside of normal office hours and acted promptly on the findings. The manager was previously required to undertake regular supervision and monitoring of senior staff in order to ensure consistency of care practices. A comprehensive appraisal system has been introduced which is planned to be undertaken every six months. In addition there is also monthly group supervisions meetings. In order to ensure that staff are appropriately supervised and fully meet the requirement individual supervision needs to be undertaken with staff, a minimum of six times per year. This should cover all aspects of practice, philosophy of care, and career development needs. Although much progress has been made to address this previous concern the inspectors felt that this requirement had not yet been fully met. Generally records required by regulation for the protection of residents and for the effective running of the home were satisfactory maintained, with the exception of risk assessments, care plans, police checks and food. All records were kept secure. Written guidance is available on issues related to health and safety and good practices were evident in the following: • A record of accidents was maintained including a record of the after care provided following any injury. • Regular maintenance checks and service contracts are in place for equipment. • Regular fire drills, training and servicing of equipment. • Hot water was delivered to outlets used by residents within the safe temperature zone. • Window restrictors are now regularly checked to ensure that they remain in position. However, further work is required as a matter of priority to improve the management of risks, this includes: Grosvenor Lodge H59-H10 s14201 Grosvenor Lodge v220087 230505 stage 4.doc Version 1.20 Page 24 A ground floor bathroom, which was not locked and in the process of being refurbished contained hazardous cleaning chemicals, which were accessible to residents. • The bathroom on the top floor, although no longer in use, contained a tray of cutlery, some mugs and the bath had a water temperature of 61 oc. • The fire escape leading from the top floor onto a flat roof must be risk assessed to ensure that it provides a safe fire exit route. • Some fire doors on the ground floor remain propped open using wooden doorstops and therefore present a significant risk in the event of a fire. This has been raised during previous inspections and despite previous reassurances has not yet addressed. Further failure to comply will now result in legal advice being sought on this issue. The manager was previously required to ensure that the external fire escape was made safe. During the inspection a new fire escape was in the process of being installed. • Grosvenor Lodge H59-H10 s14201 Grosvenor Lodge v220087 230505 stage 4.doc Version 1.20 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x x 2 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 4 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION 3 3 2 3 x 3 3 1 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 1 2 x 3 x x 2 2 1 Grosvenor Lodge H59-H10 s14201 Grosvenor Lodge v220087 230505 stage 4.doc Version 1.20 Page 26 YES Are there any outstanding requirements from the last inspection? 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 7 Regulation 15(2)(c) Requirement That evidence is provided that service users or their representative have seen and agreed the contents of their care plan. That manual handling risk assessments include the safe handling techniques to be used with individual service users and which are reviewed frequently. That a programme of activities be developed based on the likes and dislikes of service users and which is made available to service users. That so far as practicable the home enables service users to make decisions with respect to the care they are to receive and their health and welfare. (Previous timescale of immediate not yet fully met) That the use of a reclining chair is supported by the service users or representatives written consent and completion of a risk assessment, which is reviewed regularly. That staff wear appropriate protective clothing when entering the kitchen. Timescale for action 30-9-05 2. 7 13(5) 30-8-05 3. 12 16(2)(m) 30-8-05 4. 14 12(2) Immediate 5. 14 13(4)(c) Immediate 6. 15 13(3) Immediate Grosvenor Lodge H59-H10 s14201 Grosvenor Lodge v220087 230505 stage 4.doc Version 1.20 Page 27 7. 15 17(2) Sch 4 (13) 8. 18 13(6) & 9(2)(b)(i) 9. 26 13(3) 10. 11. 26 28 23(2)(d) 18(1)(c) (i) 18(1)(a) 18(2) 12. 13. 30 36 14. 38 23(4)(a) 15. 38 13 16. 38 13(4)(c) That the record of food provided is recorded in sufficient detail to enable any person inspecting the record to determine whether the diet is satisfactory, in relation to nutrition and otherwise, and of any special diets prepared for individual service users. That the manager undergo adult protection training for registered managers provided by Brighton and Hove social services. (First made during inspection of the 28/9/04). That suitable arrangement are in place to prevent infection, toxic conditions and the spread of infection at the home. That all parts of the home are kept clean and hygienic. That persons in charge in the absence of the manager are suitably qualified. (First made during inspection of 19/1/04). That staff receive training in infection control and COSHH. That staff receive regular recorded formal supervision by the manager. (Previous timescale of 30/3/05 not yet fully met) That fire doors are not wedged open using none automatic fire door closure mechanism. ( First made during inspection of 19/1/04). That bathrooms currently not in use, or undergoing refurbishment are made secure to avoid service users accidentally entering. That hazardous substances are securely stored within the home at all times. Immediate 30-9-05 30-8-05 30-6-05 30-9-05 30-9-05 30/3/05 Immediate Immediate Immediate Grosvenor Lodge H59-H10 s14201 Grosvenor Lodge v220087 230505 stage 4.doc Version 1.20 Page 28 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. 3. 4. Refer to Standard 15 15 24 26 Good Practice Recommendations That the cook undergo specialist food training on catering for people with dementia and Alzheimer’s. That the needs of a service users be established as to whether specialist cutlery is needed. That the practice of labelling a chests of drawers with residents name be reviewed. That the method of cleaning bedroom floors be reviewed to ensure that standards of cleanliness can be maintained throughout the home while bedrooms are being cleaned. Grosvenor Lodge H59-H10 s14201 Grosvenor Lodge v220087 230505 stage 4.doc Version 1.20 Page 29 Commission for Social Care Inspection Ivy House, 3 Ivy Terrace Eastbourne East Sussex BN21 4QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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 Grosvenor Lodge H59-H10 s14201 Grosvenor Lodge v220087 230505 stage 4.doc Version 1.20 Page 30 - 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. 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