Inspection on 03/01/07 for Grovelands

This inspection was carried out on 3rd January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Grovelands 27/02/06

Grovelands 05/12/05

Grovelands 26/03/05

Grovelands 03/09/04

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

CARE HOMES FOR OLDER PEOPLE Grovelands 45 Grove Avenue Yeovil Somerset BA20 2BE Lead Inspector John Hurley Unannounced Inspection 3rd January 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Grovelands DS0000061698.V319008.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. Grovelands DS0000061698.V319008.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Grovelands Address 45 Grove Avenue Yeovil Somerset BA20 2BE 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) 01935 475521 01935 472608 Somerset Care Limited Mrs Jacqueline Bridie Howells Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places Grovelands DS0000061698.V319008.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection Brief Description of the Service: Groveland’s currently provides residential services for 25 adults within the registration category of older people. Groveland’s is sited in a pleasant residential area of Yeovil. The town centre is about one mile away. There are bus services with stops nearby and local shops, pubs, clubs and doctors’ surgeries close to the home. A large garden surrounds the building with level access from various exits in the home. (This area is currently inaccessible due to major building works). The home aims to provide a homely atmosphere where service users feel included in every aspect of the life in the home, where their views and preferences are respected and rights promoted. Grovelands DS0000061698.V319008.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first unannounced key inspection of Groveland’s since its transfer to a purpose built home in September 2005. The inspection process followed the Commission for Social Care Inspection Inspecting for Better Lives methodology. Prior to the visit the registered manager of the service completed a pre inspection questionnaire. The views of the service users and people important to them were also sought; where appropriate their comments are included in this report. The inspector toured the building, spoke with the management and staff on duty and spoke privately with service users on both an individual and group basis. They inspected a sample of the service users documentation along with records relating to staff and other documents required by regulation. What the service does well: What has improved since the last inspection? As the whole service has moved to a newly built home this marks a substantial improvement in the environment that the service user live in. The only one requirement made at the last inspection related to improving the staffing records, this has been attended too. Grovelands DS0000061698.V319008.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Grovelands DS0000061698.V319008.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Grovelands DS0000061698.V319008.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3,6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home ensures that prospective service users are provided with information regarding the home. Service users and their families are invited to visit the home and assess the services provided. An assessment of need is completed prior to any service user moving in to ensure that the home will be able to fully meet their needs EVIDENCE: The documentation relating to the new service users continues to contain good details relating to the individuals presenting issues as well as a good social history. Their assessed health and social needs are clearly recorded and evidences that health care professionals, care managers and the individuals family had been involved in the admissions process. Grovelands DS0000061698.V319008.R01.S.doc Version 5.2 Page 9 The feedback received from service users and people important to them confirms that they were included in the admissions process. This feedback further confirmed good levels of satisfaction of the process. The homes management continues to carry out their own initial assessment to ensure that they can meet the needs and aspirations of any prospective placement. These assessments include areas such as pressure sore management issues, manual handling issues as well as individual risk assessments. The registered manager informed the inspector that the home does not offer intermediate care. Grovelands DS0000061698.V319008.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The care plans and associated reviews need to accurately reflect the changing circumstances of the individual. The recording of medication administered and rationale for Per Required Needs administration of medication must improve. Service users are treated with dignity and respect. EVIDENCE: The health care needs of the service users are regularly reviewed. The inspector sampled the homes day diary that evidences that any changes in health care needs were promptly addressed by contacting the GP to arrange a visit to the home. The community nursing team addresses any nursing care needs, as the home is not registered to provide nursing care. Grovelands DS0000061698.V319008.R01.S.doc Version 5.2 Page 11 The inspector sampled a number of the service user care plans. They found that the standard of recording was variable. Some of the plans demonstrated monthly reviews and cross-referenced the homes day diary recording the outcomes of other professionals interventions and amending the care plan as required, others did not. On one-service users file the inspector found that the manual handling assessment was at best ambiguous, stating that if the person cannot weight bear they must be assisted to their feet to stand by the use of a hoist, although the documentation acknowledges the persons reluctance to speak or cooperate. Through discussion with the staff on duty the inspector established that the individual in question would not weight bear at anytime, by choice. This was not clearly evidenced in the service users documentation. Medication is supplied by a local pharmacy and dispensed using a NOMAD system. A list of staff trained to administer medication and a sample of their signatures is available at the beginning of the medication recording sheets. All medications are stored securely. The inspector viewed the medication administration recording sheets and noted a number of issues that needed to be addressed. Some directions required medication on a Per Required Needs (PRN) basis but the rationale for administration on this basis was not always available (either on the medication sheets or service users file). The inspector found gaps in the recording of administration of medication. It was also noted that for those service users who self medicate the home collects the medication on the individual’s behalf and gives it to them. However they (the staff) do not record when medication has been given to the individual service user so that a complete audit trail does not exist. The inspector asked a staff member who had responsible for medication administration if there were any controlled drugs on the premises, they replied no. However the inspector pointed out that a controlled preparation was in the medication cupboard. This preparation had not been correctly signed or accounted for. The registered manager acknowledged this error and took steps to rectify this situation during the inspection. The inspector was able to talk with many of the service users some of which by choice spent much of their time in the privacy of the own rooms. These service users expressed how much they appreciated that the care staff fully respected their privacy and dignity and that they were not made to do anything they did not wish to, such as attending activities or having meals in the dining room. Service users confirmed that all personal care was provided in the privacy of their bedrooms or communal bathrooms. Grovelands DS0000061698.V319008.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has taken appropriate action to meet service users’ social needs. Service users are encouraged to exercise choice over their lives. Meals are of a good standard and offer a well-balanced diet. EVIDENCE: The pace of life at the home appears to meet the expectations of the service user group. The service users who the inspector spoke with said they were happy with their lifestyle. The service user documentation shows that some individual service user access the local community independently or with little assistance, such as arranging taxis. The inspector was informed of the planned activities. These provide extra stimulation to the service user group. These range from singing and bingo, gentle exercise, ball type games and outings. Several service users told the inspector that they knew what activities were taking place, some they liked others they did not. Given that the home provides two good sized communal areas on each floor those who choose not to participate do not have too. Grovelands DS0000061698.V319008.R01.S.doc Version 5.2 Page 13 Service users were able to confirm that they could receive visits from family and friends at any time, in the privacy of their bedrooms or in one of the communal rooms. A record is maintained of all visitors to the home. They also commented that they could get up and go to bed when they choose. Interaction between staff and service users was observed as friendly and respectful. Comment cards returned to the inspector from other visiting professionals further confirmed this. The main hot meal of the day was served at lunchtime, which was well presented and nicely cooked. Service users were complimentary of the food provided with no complaints received regarding the quality of the food. Two pleasant dining rooms are provided which many of the service users were seen using, however service users were also able to receive their meals in the privacy of their bedrooms if they wish. Service users needing support with their meals were provided with one to one assistance by a carer. Grovelands DS0000061698.V319008.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home has appropriate policies relating to complaints and the protection of vulnerable adults. EVIDENCE: The manager maintains a complaints register, the home has received two complaints in the last year. These complaints have been dealt with in line with the organisations stated policy. A clear complaints policy and procedure is in place and is clearly displayed for service users and visitors. Through conversation it was evident that the manager had a clear understanding of the local vulnerable adults procedure and how to implement the procedure in the event of receiving an allegation of abuse. The manager reported that the staff had recently received training in “Adult Protection”. Grovelands DS0000061698.V319008.R01.S.doc Version 5.2 Page 15 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is clean safe and meets the needs of the service user group. The use of keypads in-between the first and second floor needs to be agreed with all service user. EVIDENCE: The home is newly constructed having only been occupied since September 2006. The building is on two floors with a interconnecting lift and staircase. All of the service user rooms have been finished to a good standard all have ensuite facilities. The inspector toured the premises both accompanied and unaccompanied. As with all new buildings there is a degree of “settling down” but all of the issues regarding minor faults are easily rectified by the contractors who are still on site building the second phase of the project. Grovelands DS0000061698.V319008.R01.S.doc Version 5.2 Page 16 The home has a range of adaptations and fittings to enable the individual to retain as much independence as able. The communal bathrooms have all of the necessary equipment with which to deliver a safe service. One slight oversight with the bathroom and toilet areas is the provision of storage facilities, the registered manager agreed to address this without delay. The service users expressed high levels of satisfaction with their new home and considered it to meet their needs very well. They further confirmed that they had been consulted with regards to the soft furnishings such as curtains and duvet covers etc. The inspector noted that on the second floor there was a strong smell of cigarette smoke, the manager confirmed that there is a dedicated smoking room. The inspector considers that the arrangements made to ventilate this dedicated room are inadequate. It was further noted that the first floor is separated from the second floor by way of keypads (coded access through locked doors) This is considered unnecessary as no real risk assessments have been made to support the use of these keypads. In mitigation the registered manager informed the inspector that all service users can use the lift unaccompanied thus bypassing the need to go through the doors. As this may be seen as a form of restraint(denying someone’s liberty to move freely around their environment) it needs to be made clear on the service users documentation that they are in agreement with the use of the keypads. Grovelands DS0000061698.V319008.R01.S.doc Version 5.2 Page 17 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 good This judgement has been made using available evidence including a visit to this service. Staff are provided with appropriate training to undertake their role. There are sufficient staff on duty to meet service users’ needs. provided with regular supervision. EVIDENCE: Duty rotas are maintained. There are generally four staff on duty throughout the day, and two waking staff at night. Additional domestic and catering staff are also employed. The deployment of staff into which area they will work, (first or second floor) is on a daily basis. The inspector considers that some further thought should be given to this as good practice would indicate that continuity of staff is seen as useful in establishing and maintaining good service delivery especially to those service users who may be easily confused. New staff confirmed that they have undergone a thorough recruitment and selection process by way of a formal interview and statutory checks to establish their suitability to work in the home. All new staff receive a comprehensive induction when they start at the home, one staff member has responsibility for supporting each of them through this process. All elements of the induction process are signed by both parties to confirm the element has Grovelands DS0000061698.V319008.R01.S.doc Version 5.2 Page 18 Staff are been completed and understood. In addition to this new staff complete the mandatory training required by the regulations. This induction process is excellent as it ensures that new staff have the skills required to start supporting people at the service. Staff receive regular supervision, and appraisals are completed on an annual basis. Staff stated that they enjoyed working at the home, and received appropriate support. The inspector noted that whole staff meetings are a regular feature of the service. All staff attend these meetings, separate meetings being held for domestic, catering, care and senior staff to complement the whole team meetings . Staff have undertaken mandatory training such as Fire Awareness, Moving and Handling, Food Hygiene and Infection Control. Some staff have also attended various day courses. Some care staff has undertaken the NVQ Award in Care at varying levels. Grovelands DS0000061698.V319008.R01.S.doc Version 5.2 Page 19 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): 31,33,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home continues to be well managed and provides a needs lead service. EVIDENCE: There have been no changes to the homes management since the last inspection. The management continue to have a good understanding of the National Minimum Standards required and how they should be met, but more attention should be paid to their responsibilities with regards to the administration of medication. Grovelands DS0000061698.V319008.R01.S.doc Version 5.2 Page 20 The staff informed the inspector that the management are fair with their decisions in relation to the running of the home and feel that their manager will support them in the best way that they can. There continues to be good monitoring of health and safety at the home. All staff spoken to confirmed that they had received extra training on the new equipment that has been provided. The inspector viewed the statement regarding the use of the passenger lift and what to do in the event of a breakdown. The inspector would strongly recommend that the lift company endorse the stated procedure and a copy of their endorsement is kept on file for future reference. Grovelands DS0000061698.V319008.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x x x x 3 Grovelands DS0000061698.V319008.R01.S.doc Version 5.2 Page 22 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 OP7 Regulation 15 (1)(2)(a) (b)(c)(d) 13 (4)(c) Timescale for action Unless it is impracticable to carry 31/01/07 out such consultation, the registered person shall, after consultation with the service user, or a representative of his, prepare a written plan (“the service users care plan”) as to how the needs in respect of his health and welfare are to be met. The registered person shall – make the service users plan available to the service user; Keep the service user plan under review; Where appropriate and unless it is impracticable to carry out such consultation, after consultation with the service user or a representative of his, revise the service users care plan and notify the service user of any such revision. The registered person shall ensure that unnecessary risks to health or safety of the service user are identified and so far as possible eliminated. Grovelands DS0000061698.V319008.R01.S.doc Version 5.2 Page 23 Requirement This is with specific reference to 1. Carrying out full and comprehensive risk assessments following significant incidents ie falls, which are robustly evaluated and guide and inform the monthly reviewing process carried out by the home. 2. Ensuring that manual handling assessments are comprehensive and un-ambiguous 3. Nutritional assessments are in place for each service user. 2 OP10 13(2) The registered person shall make 31/01/07 suitable arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. This is with specific reference to ensuring that all medicines administered via the PRN route are done so in line with the homes policies and procedures and a rationale for giving medication via this route established. Reasons why the staff gave the medication and the outcome of the intervention must be recorded. Also the responsible individual must ensure that all medication administered is recorded in line with the homes policies and procedures. Grovelands DS0000061698.V319008.R01.S.doc Version 5.2 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP25 OP10 Good Practice Recommendations The registered manager should consider making alternative arrangements for the ventilation of the smoking room on the 2nd floor. The registered manager should consider looking at alternative arrangements for the storage of personal care products in the toilet areas Grovelands DS0000061698.V319008.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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 Grovelands DS0000061698.V319008.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!