Inspection on 05/03/07 for Grosvenor Park Nursing Home

This inspection was carried out on 5th March 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 Park Nursing Home 16/02/09

Grosvenor Park Nursing Home 30/11/05

Grosvenor Park Nursing Home 31/05/05

Grosvenor Park Nursing Home 29/11/04

Grosvenor Park Nursing Home 21/05/04

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

CARE HOMES FOR OLDER PEOPLE Grosvenor Park Nursing Home 26 Brookfield Road Bexhill On Sea East Sussex TN40 1NY Lead Inspector Lynnette Gajjar Key Unannounced Inspection 5th March 2007 09:35 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 Park Nursing Home DS0000013992.V326130.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 Park Nursing Home DS0000013992.V326130.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Grosvenor Park Nursing Home Address 26 Brookfield Road Bexhill On Sea East Sussex TN40 1NY 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) 01424 213535 01424 732451 smjane@bupa.com www.bupa.com BUPA Care Homes (BNH) Limited Jane Lynda Smith Care Home 57 Category(ies) of Old age, not falling within any other category registration, with number (57) of places Grosvenor Park Nursing Home DS0000013992.V326130.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 30th November 2005 Brief Description of the Service: Grosvenor Park is owned and run by BUPA Care Homes, and is registered to provide care for those over 65 years who require personal and nursing care. The home admits residents who are privately funded and also those who are funded by social services. Grosvenor Park admits a number of residents for respite and holidays. The home is purpose built and situated in a residential area enjoying views of the seafront, shops are within walking distance and the home is convenient for public transport. Residents can enjoy four lounges, a large dining room and a library room. There are attractive gardens, which are accessible to wheelchair users and these are used when weather permits. Grosvenor Park current fee range from £120 to £140 per day and are dependent on services supplied. These include respite residential care and nursing care, permanent residential and nursing care, single, and double and en-suite bedrooms. A full and detailed breakdown is available from the Manager. The local Primary Care Trust undertakes Free nursing care fees and assesses Residents on or soon after admission. Fees are then amended to take this into account where applicable. Top ups may be charged for differences between local authority rate and the actual room rate if residents wish to remain in a particular room when funding responsibility changes. Additional charges include Newspapers, hairdressing; toiletries vary depending on personal choice. The homes inspection reports are available for reading at the home. Grosvenor Park Nursing Home DS0000013992.V326130.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key unannounced inspection, for the year running from April 1st 2006 to March 31st 2007. The visit lasted from 09.35am until 16:56pm. At the time of this visit Grosvenor Park had fifteen vacancies, with thirty-eight ladies and gentlemen in residence. Those living here preferred to be referred to as residents and so respected through out the report. The visit was spent talking directly with residents privately and collectively, care and ancillary staff, visitors and the manager. The inspector spent the time sitting with residents in the lounge and dining room, which gave opportunities to observe interactions during the day. This report includes evidence and judgements made through conversation, observation, records and previous inspection reports. Additional information was obtained through receipt of the manager’s pre-inspection questionnaire, a partial tour of the premises and conducting a case tracking exercise, by reading the files and care plans of the two resident and two care staff, as well as some policies and records maintained by the home. ‘Have your say’ Questionnaires feedback was also received from a further 16 residents and 4 relatives/carers. Overall the ladies and gentleman living here, and relatives are very satisfied with the service received. Samples of comments received are included in the report: “Freedom of choice to make own decisions” “The activities arranged within the building are EXCELLENT. It would be appreciated if some form of transport for outings could be arranged.” “Provides a good professional routine that ensures a feeling of confidence, comfort and security. Bright well maintained environment, lounge area like a nice hotel with seating arrange in groups Service in dining room very attentive Staff work as a good team throughout are committed to the job.” “I think the general standard is very good. Our new manageress is excellent ad is always available for residents to talk to her.” “Another lift would be good, at the other end to the one installed, it gets very busy at times” Grosvenor Park Nursing Home DS0000013992.V326130.R01.S.doc Version 5.2 Page 6 Good progress has been made with requirements made at the last inspection with only one being carried forward but assessed as partially met. Due to the very positive responses to the new manager at Grosvenor Park and commitment to offer a responsive and good service to the residents, a number of good practise recommendations have been made rather than requirements under the Care Standards Act 2000 to improve resident personal care and independent safety from the managers’ assurance they will be followed through. What the service does well: Grosvenor Park has a calm, relaxed and pleasant atmosphere and it is run in the best interests of the residents. It is decorated and furnished to a good standard, and is clean, bright and airy. Residents are happy and contented, like living there, feel well cared for and are treated with respect. Overall those spoken with said they felt safe, expressed confidence in the care staff and manager to listen to them and “feel good” in themselves. “The sisters really know their job really look after you. The activities organiser tries to think up new things all the time we have great fun. Mrs Smith the manager has always got time or you if you want any help; she is a very caring person The home is very well run and I wouldn’t like to be anywhere else – ALL the staff are marvellous.” Personal health care needs are well supported. Residents are encouraged to maintain regular contact with external agencies and professionals to managed their health care and personal preferences. Health professionals feel staff are caring and also have good communication about their patients care. Family and friends are encouraged to be involved in the life at the home with visits welcomed. Residents and relatives can make comment about the service and know action will be taken. “Exceptional attention to the comfort happiness of my parents. The senior staff are always much in evidence. The home has more the feeling of a good hotel than a care home. This home is very well run indeed – the care atmosphere staff are exemplary.” The home continues to benefit from a stable and highly motivated care team with an experienced manager, who enjoy their work and provide a good quality of life for residents. “The carers are dedicated to the residents care and their well being Grosvenor Park Nursing Home DS0000013992.V326130.R01.S.doc Version 5.2 Page 7 The administration ensures that the residents are consulted on various concerns with their environment The chef and staff on the food service area are committed to providing nutritious, wholesome meals. They provide varied meals Regular activities are provided to keep residents amused and engaged.” What has improved since the last inspection? What they could do better: Residents and staff would benefit from clearer and more specific guidelines in the administration of PRN medication, such as what exactly the medication is prescribed for and visual triggers and indicators of when medication is to be administered. Residents would benefit from alternative formats of the service user guide (such as audio and visual) being developed to assist those with sensory loss in understanding where they are moving too and familiarity of staff when arriving at the home. Locally funded residents would feel more secure if they had a statement of terms and conditions with the provider that explains the service provided. Breaking down in detail the home and residents’ obligation in relation to the fees charged, a break down of fees, who is responsible wholly or part for payment of fees and details of trial periods. Grosvenor Park Nursing Home DS0000013992.V326130.R01.S.doc Version 5.2 Page 8 Staff induction, training and supervision records could be better documented and in a format that is easy to reference and tracking. Residents accessing the grounds, fire doors/windows personal safety and security could be enhanced further from assessment by an Occupational therapist and installation of equipment to improve independent mobility and safe use of fire doors and windows leading to high balconies. 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 Park Nursing Home DS0000013992.V326130.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 Park Nursing Home DS0000013992.V326130.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): 1,2,3,4,5,6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The ladies and gentlemen living at Grosvenor Park and their representatives have access to the information needed in making a decision as to whether the home can best meet their needs. Supplying local authority funded residents with formal terms and conditions of residence would install security and understanding of fees charged and payment responsibility as privately funded residence experience. EVIDENCE: The home has developed a statement of purpose (SOP) and service user guide (SUG) following BUPA templates. These are in need of reviewing to ensure that they reflect the home’s current registration and fees breakdowns and changes in regulation last year. Both are in written formats that can be reproduced in larger font if required. Alternative formats should be explored to assist those with more visual/ audio information and prompts, particularly for those who are unable to visit the home and or have sensory loss. Grosvenor Park Nursing Home DS0000013992.V326130.R01.S.doc Version 5.2 Page 11 Where possible residents have had the opportunity to visit the home prior to moving in, many having tasted the service through respite care having first hand experience. Others due to their medical needs have left this to their families to visit and view a number of homes. All those spoken with and responded to questionnaires felt they were given more than enough information about the home. Comments included: “Stayed one month before making a decision”, “I came on a short stay before taking permanent residence so knew how good it was”. “A representative from Grosvenor Park visited me at home before I came in and gave much useful information” “I came on several short breaks so was confident it was a good home”. Local authority funded clients have a care management assessment undertaken and this is supplied to the home detailing care and support needs. Grosvenor Park Nursing staff undertakes their own assessments too following BUPA admission procedures and formats. Copies of assessments were seen in standex files and transferred into the care plan Private service users are given printed contracts pertaining to the fees and terms and conditions of residence. The local authority has a service level agreement with the home for those placements funded by them. Local Authority funded residents do not currently have terms and conditions between them and the home, detailing what the services are they will receive, terms of the placement, what the fees are, who part or wholly funds this and is responsible for the payment of fees. “No contract respite care via Social Services” What could improve – “perhaps by not increasing fees end of year by 6 , which probably stops some people coming here”. “Very clear explanation of both financial aspects rules and regulation” Residents are assessed after admission by the local PCT for their Free Nursing Care element and once the PCT have agreed this, fee are amended accordingly. The manager was not aware of the amended Care Homes Regulations June 2006 regarding SUG and fees. To ensure accurate and detailed information about fees charges, Free nursing care elements, responsibilities for payment are clearly defined in the SUG and Contract. Information was shared on how to access the regulations and the manager stated a review of these documents would take place to meet the new regulations with the head office. Grosvenor Park Nursing Home DS0000013992.V326130.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents continue to receive a high standard of personal and health care. EVIDENCE: Two individual care plans were tracked, giving detailed and personal information about the support required by the individuals. Those spoken with described very personal, consistent, safe care and support given by the care staff. There is scope for further improvement in recording choices and personal preferences that so many staff know personally to ensure consistent support is respected and followed through by others. Direct observation demonstrated staff on duty showing good consideration and respect for each resident on a personal level. More detail in daily records would evidence the good care observed and described by residents. The organisation is moving away from the current Standex format care plan to ‘Quest system’. Staff are to receive formal training in using this new care panning and recording system. Alternative lockable storage will need to be considered for this. Grosvenor Park Nursing Home DS0000013992.V326130.R01.S.doc Version 5.2 Page 13 The health and personal care needs of the ladies and gentleman are well supported with regular contact with specialists and external professionals. “I have seen our friends treated and very happy in all that is done for them.” “I am a residential and not patient but recently had a hip replacement and had every care I could wish for over six weeks full recovery. During my recovery, the bell was answered within minutes, which is excellent as they are very busy on the nursing floor.” Interaction between residents / relatives and staff is good showing genuine respect, friendship and appropriate familiarity with each other. Resident meetings are planned and well attended. “Friendship love and care great, very caring, feel very loved and cared for here. This place feels and is a very caring home.” Safe medication practice is encouraged with regular monitoring and auditing by the senior nursing staff. Residents and staff would benefit from more detailed guidelines of what PRN medication is given for and specific triggers or indicators for administration, particularly for those who may be more confused and ensure consistent dispensing by staff. Good medication storage and administration was observed during this visit. Using formal falls management assessment tools, which can be accessed through local PCT, could enhance risk assessment and management of falls experienced by some residents. Further individual information could be discussed with residents and families about the personal contact and action expected by staff at such times of illness and to respect the personal wishes leading to the end of one’s life. So as to offer the personal support, respect, care and dignity required at this time. Grosvenor Park Nursing Home DS0000013992.V326130.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents continue to live in a home where they can be active and have social contacts of their choices and at a pace suitable them. EVIDENCE: Grosvenor Park has an activities organiser to arrange activities in the home. A programme of events planned was displayed in the home, which is joined in by residents as they wish, and well known by residents spoken with. Activities today included an exercise session and quiz, both well attended and enjoyed by residents. “Regular activities are provided to keep residents amused and engaged.” “And very good they are.” Residents were observed sitting in the lounge, entrance hall and dining room listening, reading magazines and chatting to each other. Others we in their rooms happily occupying themselves reading, watching TV, Listening to radio or receiving visitors. Attendance at any activity is purely voluntary, staff recognise the personal interests and concentration span and are quite happy that they ‘drop in and out’ of activities. Visitors are also encouraged to join in. Grosvenor Park Nursing Home DS0000013992.V326130.R01.S.doc Version 5.2 Page 15 Residents spoken with said that they enjoyed sitting in the lounges and bedrooms and when the weather is better making use of the gardens and walks along the seafront. Residents were observed to walk freely around the home and engaging in conversation with peers and staff. Religious services are arranged in the home and where possible supported to attend. “ Activities this is one of the reasons I chose to come here rather than elsewhere, with easy access to a walk on the seafront, gives pleasant and easy exercise” “ Activities a) relieve boredom b) give you the chance to make friends with other residents” Staff aim to ensure that just because the older person is in a residential home, their right to choice and decision making isn’t taken away. Whilst there are some normal restrictions as part of any group living situation, residents have choice in such areas as times of getting up and going to bed, when to have their bath/shower, where they would like to eat and what they would like to do with their day. Residents are encouraged to bring personal possessions with them and every effort is made so that they are in an environment where they feel content. Menus are prepared in advance and residents choose what they want from the menu. The only day before notice required is for hot breakfast or special items not on everyday selection. There are two main courses available each day with starters and a wide selection of alternatives snacks/ light meals. There are hot and cold puddings available to choose from. The dining room is staff by a dedicated chef, catering staff and waiters, offering full sea front hotel silver service dining and relieving care staff to support those with additional support at this time. Option of juices ad glass of wine with dinner, after dinner coffee and cheese and biscuits are also available. Many residents choose to eat in the attractive dining room over looking the sea front. Those wishing to eat in their rooms are supported to do so with full care staff support, food is delivered to each floor on heated trolleys and serve by staff as required by residents. Most residents spoken with felt there is always a good choice and the food is well cooked and there is “always a lot of it. However concerns have been raised regarding the quality of meat supplied and being to tough, through residents meetings. The chef and manager have met with suppliers to try to address this in the past few weeks. Comments received from this visit from residents included: “Service in dining room very attentive” “Meat is sometimes tough and tends to be over cooked. Names of dishes are often impressive and misleading – on the printed menu. Hot sweets are Grosvenor Park Nursing Home DS0000013992.V326130.R01.S.doc Version 5.2 Page 16 generally of high calorific value – not suited to those of low mobility or immobile.” “There is always a choice of meals”, “It must be difficult to cater for many different tastes and I think the kitchen has to work on a very low budget. When we have a roast, the meat to my mind is very over cooked.” “The chef and staff on the food service area are committed to providing nutritious, wholesome meals. They provide varied meals” “I wish there was less curry.” “More diabetic food needs to be available” “Meals are monotonous after 4.5 years” “Many choices of meals.” Resident’s families and friends are in regular contact, with an open door visiting policy. A steady flow of visitors was observed through out the day and in discussion spoke with fondness and familiarity about care and management staff directly to the inspector and thorough questionnaires received. “I have been coming here to visit my friend last two years. I have seen how wonderfully well people are treated and one day I be pleased to join them” The ladies and gentlemen were observed to be stimulated and comfortable in their home. Grosvenor Park Nursing Home DS0000013992.V326130.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): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Those living here and their relatives feel very confidant to raise concerns or complain to the manager and staff, as they feel they are listened too, and that every action will taken to resolve them. Protection from abuse is promoted through all staff receiving training and understanding of the support and actions they may need to take in incidences abuse. EVIDENCE: The home has a clear written complaint procedure, that has been revised by the new manager to record verbal concerns and action taken offering a more robust system to monitor views and trends from residents but also action taken. Documentation requires updating with the new local CSCI office address since it move last month. They have received 6 concerns since Oct 2006 when the record begun. All have been managed effectively and within timescales set in the homes procedure. For example; resulting in meetings with the chef and meat supplier following concerns that meat serve was tough. Of those spoken with directly all felt staff listened to them and the manager was always available to hear their concerns and take action if needed. Grosvenor Park Nursing Home DS0000013992.V326130.R01.S.doc Version 5.2 Page 18 Questionnaires also indicated a very positive feedback to the responsive nature of the manager to any concern raised but more importantly that they had not had to raise concerns but if did, had every confidence it would be dealt with quickly. “The manager is very helpful and listens to what you say. Have nothing to complain about” “Criticisms made are made in light of the monthly rate of charge, which I pay.” “Very good listeners, follow all correct procedures for lifting, very prompt active in responding to calls Cheerful respectful of individuals dignity” “No complaints have been necessary. I have the documentation needed to check the complaint procedure” The Commission has not received any concerns regarding the home either. Training records indicate some staff has undertaken training in Adult Protection with others booked to undertake in the future, but tracking numbers was difficult to define on records available. Staff who have been spoken with evidenced a good understanding of how to protect and prevent abuse, including reporting to their nurse in charge or manager to discuss further and report to Social Services and the Commission. The home has a copy of local authority adult protection procedures. The manager discussed her actions in the event of an adult protection alert, showing her understanding, openness in close working with Social Services, Police and CSCI. The home does not have any current adult protection investigations. Or had any since the last inspection. Care plans seen had assessments in place and consent for the use of bedsides, where this was assessed as appropriate to personal safety and/or in one case personal choice for security. Grosvenor Park Nursing Home DS0000013992.V326130.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): 19,20,21,22,23,24,25,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The ladies and gentlemen live in a clean, comfortable and well maintained home which will be further enhanced through the planned refurbishment/decoration of home. Further safety assessments to access external gardens, fire doors and windows with equipment installed will promote independence and personal safety. EVIDENCE: Grosvenor Park is purpose built situated right on the sea front of Bexhill on Sea, with beautiful views over the sea front and attractive gardens and flats to the rear of the property. Being located on the sea front there is high maintenance required to the external property. It provides a very light and airy environment with good accommodation to meet the needs of the residents. During the site visit it was noted that a good standard of decoration Grosvenor Park Nursing Home DS0000013992.V326130.R01.S.doc Version 5.2 Page 20 and cleanliness is maintained, and redecoration of rooms was being progressed at the time of this inspection. Comments received included: “Standards of room care has latterly declined with less responsibility for different areas of the home.” “The home has more the feeling of a good hotel than a care home” Grosvenor Park is registered for 57 beds, the manager stated due to nursing care and double rooms not being suitable for this, the home will satisfactorily provide 53 nursing care beds at any one time. The second floor has been refurbished to allow for further nursing care beds with a new clinical room, nurse station, sluicing facility installed. The rooms are not yet fully functional, as all nursing beds and equipment have not yet been delivered. The manager will not open these beds and located nursing staff on this floor until all equipment is in place to offer a satisfactory standard expected by this home. All floors are accessible by large wide staircase or one shaft lift. “Another lift would be good, at the other end to the one installed, it gets very busy at times” Advise should be sought regarding safe and independent access to the external garden and grounds by an Occupational therapists to ensure adequate surface cover, ramps, grab railing, highlighting paint to steps etc is used to promote independence and reduce the risk of falls. This is an invaluable resource and one commented upon by residents as one reason they chose those home, it location to the sea front and opportunity for exercise. It was also recommended fire doors and windows on balconied rooms are risk assessed with appropriate safety alarms and window restrictors installed as deem necessary to promote personal safety and security to individuals living here. The laundry has two rooms available for clean and soiled laundry facilities but currently one room is predominantly used or both. Opposite this laundry is a large shelved drying room with is ideal as a separate clean and drying storage thus separating the two and promoting improved good infection control measures. The manager agreed to explore this. Grosvenor Park Nursing Home DS0000013992.V326130.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s benefit from the support of a confident and motivated staff team, resulting in good morale and enthusiasm to improve the ladies and gentlemen’s whole quality of life. Further development of the training documentation and induction of staff will ensure a more a robust system. EVIDENCE: There were 38 residents living in Grosvenor Park at the time of this inspection. There was adequate care ancillary and catering staff on duty to meet the needs of residents during this visit. One noticeable indicator was the low use of call bells during this visit and residents relatives comments of the speed in which call bells are responded too. “Personal presentation of all staff.” “Staff are always kind and helpful.” “The carers are dedicated to the residents care and their well being.” “The senior staff are always much in evidence.” “I am very impressed by the members of staff on duty the rapid response given to any wish. The sisters really know their job really look after you. Staff work as a good team throughout are committed to the job.” “Recently shortages of staff due to sickness etc are not made up by the use of agency carers. Staff are therefore often rushed off their feet.” Grosvenor Park Nursing Home DS0000013992.V326130.R01.S.doc Version 5.2 Page 22 “Very good listeners, follow all correct procedures for lifting, very prompt active in responding to calls” “Cheerful respectful of individuals dignity” Throughout the inspection there was evidence of very good staff/resident interactions. It was clear that staff listened, got to know individuals and was approachable. Staff balance personal care needs with time for one to one chats, activities and recording daily events. During the inspection 2 care staff recruitment files were examined and were found to be full and complete. The staff training records for 3 staff members were reviewed and identified that induction training that meets the National Training Organisation workforce training targets however timescales for completing some core basic training was a 3 months after their start date. For staff that have worked in the home for some time regular staff training on core areas was difficult to track and evidence. Individual training and development assessment/ profile has been introduced since the last inspection but not adequately completed to successfully audit and track individual training undertaken or due without tracking every course attended recently and ticking staff names off. The pre inspection training information indicated training had been undertaken in core areas identified in previous inspections but tracking this was not possible during this site visit. The training member of staff was not available to explain the record and monitoring system. Grosvenor Park Nursing Home DS0000013992.V326130.R01.S.doc Version 5.2 Page 23 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): 31,32,33,34,35,37,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ benefit from living in a home that is well managed, safeguards their best interests and promotes and protects their health, safety and welfare. Better record keeping would validate the good care and practices observed and better protect residents and staff. EVIDENCE: The home has recruited a new manager who has been registered by the Commission from 3rd November 2006. Mrs Smith is a registered Nurse and has 40 years experience and is undertaking Registered Managers award. Comments received about the new manager were totally positive: “The manager is very helpful and listens to what you say.” Grosvenor Park Nursing Home DS0000013992.V326130.R01.S.doc Version 5.2 Page 24 “I think the general standard is very good. Our new manageress is excellent ad is always available for residents to talk to her.” “Mrs Smith the manager has always got time or you if you want any help, she is a very caring person” “This home is very well run indeed – the care atmosphere staff are exemplary.” “Great personal interest by the manager” The home has systems in place to monitor the quality of care in the home which include regular resident and staff meetings, a self audit tool and resident questionnaires that have been audited and reported in a satisfaction survey. This survey records a improved satisfaction with the home since the new manager has been in post. All records relating to health and safety matters were found to be full and thorough. During the inspection it was however noted that monthly auditing record f accidents/ incidences would assist the manager and deputy identify triggers and patterns forming particularly pertaining to the number of falls recorded, leading to a review of the resident s assessment and care plan. As identified through the report many outcome areas for residents are being met satisfactorily in the opinions of residents and families involved in this inspection. However some records viewed did not back up the good and sometimes excellent services and support describes, observed and given. The manager was aware of these minor deficits and will be working with staff over the coming months to look at developing the written records and tracking systems held to influence care planning and reviews and evidence the good services provided in a more formal way. Recognising that residents need access to cash for items such as hairdressing and shopping, the home will hold money for safekeeping, where the resident does not maintain this himself or herself. There is no other involvement in residents’ monies. Money for safekeeping is held individually with an associated record, which supports accountability. Expenditure and income was stated to linked to receipts and managed by the bursar of the home with external accounting audits undertaken. Identified earlier in the report reviews of the environmental risk assessments and some safety measures that could promote better residents safety and should be undertaken by the home within in reasonable timescales agreed with the Commission. Grosvenor Park Nursing Home DS0000013992.V326130.R01.S.doc Version 5.2 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. 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 2 2 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 2 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 4 3 X 3 X 2 2 Grosvenor Park Nursing Home DS0000013992.V326130.R01.S.doc Version 5.2 Page 26 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 OP1 Regulation 6 (a) (b) Requirement The registered person shall keep under review and where appropriate, revise the statement of purpose and service user guide and notify the Commission and service users of any such revision within 28 days. To be submitted to the Commission by the timescale date 2 OP30 18(1)c) That staff training is established for all staff based on individual profiles and the assessed needs of residents. This was assessed as partially met since the last inspection. 30/04/07 Timescale for action 30/04/07 Grosvenor Park Nursing Home DS0000013992.V326130.R01.S.doc Version 5.2 Page 27 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 OP1 Good Practice Recommendations The manager is familiar with amended Care Homes Regulation July 2006 pertaining the service user guide (SUG) and fees information required in SUG and contracts that is a legal requirement from September 2006 and records are amended accordingly. Residents would benefit from alternative formats of the service user guide (such as audio and visual) being developed to assist those with sensory loss and cognitive impairment in understanding where they are moving too and familiarity of staff when arriving at the home. Locally funded residents would feel more secure if they had a statement of terms and conditions with the provider that explains the service provided. Breaking down in detail the home and residents’ obligation in relation to the fees charged, a break down of fees, who is responsible wholly or part for payment of fees and details of trial periods. Daily records could more accurately reflect the good care and support given and reflected by residents. Showing personal choices and preferences of care being maintained and a full triangulation of the nursing and social care provided. The home incorporates formal risk management of falls assessments within care planning and by making contact with local PCT falls coordinator /OT to assist with referral and care plan management of reducing falls for residents at risk. Full PRN protocols be written to ensure consistent administration, recognised triggers and symptoms of ‘when required’. Closer working with GP and pharmacist to ensure directions on MAR sheets are accurate to individual need and do not state ‘as directed’. 2 OP1 3 OP2 4 OP8 5 OP8 6 OP9 Grosvenor Park Nursing Home DS0000013992.V326130.R01.S.doc Version 5.2 Page 28 7 OP11 Further individual information could be discussed with residents and families about the personal contact and action expected by staff at such times of illness and to respect the personal wishes leading to the end of one’s life. So as to offer the personal support, respect, care and dignity required at this time and recorded for those on duty to access as needed. That an assessment of the premises and facilities should be undertaken by a suitably qualified person including a qualified Occupational Therapist, to advise on the suitability of disability equipment and environmental adaptations. This has been carried over from the previous inspection. Advise should be sought regarding safe and independent access to the external garden and grounds by an Occupational therapists to ensure adequate surface covers, ramps, grab railing, highlighting paint to steps etc is used to promote independence and reduce the risk of falls. 8 OP22 9 OP26 Advice is sought from West Sussex health protection unit regarding the separation of clean and soiled laundry areas, to promote better infection control measures. If separation is required there was no resource issue just inhouse system/procedure to be changed. Development of written records and tracking systems held at the home would assist better triangulation and influence care planning and reviews and evidence the good services provided in a more formal way. Fire doors and windows on balconies rooms are risk assessed with appropriate safety alarms and window restrictors installed as deem necessary to promote personal safety and security to individual living here. 10 OP37 11 OP38 Grosvenor Park Nursing Home DS0000013992.V326130.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Maidstone Area Office The Oast Hermitage Court Hermitage Lane Maidstone Kent ME16 9NT 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. Extracts may not be used or reproduced without the express permission of CSCI Grosvenor Park Nursing Home DS0000013992.V326130.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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