Inspection on 13/03/07 for Grovely House

This inspection was carried out on 13th 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 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

Grovely House 03/10/05

Grovely House 01/07/05

Grovely House 04/10/04

Grovely House 08/06/04

Grovely House 26/02/04

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

CARE HOME ADULTS 18-65 Grovely House South Newton Salisbury Wiltshire SP2 0QD Lead Inspector Susie Stratton Key Unannounced Inspection 13th March 2007 09:40 Grovely House DS0000047627.V329406.R01.S.doc Version 5.2 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 Grovely House DS0000047627.V329406.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 Adults 18-65. 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. Grovely House DS0000047627.V329406.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Grovely House Address South Newton Salisbury Wiltshire SP2 0QD 01722 742066 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) Glenside Manor Healthcare Services Ltd Elizabeth Lillian Vince Care Home 7 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (7) of places Grovely House DS0000047627.V329406.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 3rd October 2005 Brief Description of the Service: Grovely is a 7-bedded rehabilitation unit for younger people with acquired brain injury. On the day of the inspection, the home had seven persons resident. Accommodation is provided over two floors of a domestic-style dwelling. Grovely is not the service users permanent home as, on completion of their rehabilitation programme, they will move onto a permanent placement, which suits their individual needs. Grovely is part of a group of homes, all on one campus owned by Glenside Manor Health Care Services Ltd. Mr Andrew Norman is the nominated responsible individual. He is supported by a senior management team. Mrs Beth Vince is the registered manager of the home; she leads a team of care staff. A team of therapeutic staff, including medical staff, physiotherapists, occupational therapists and psychologists are employed to work across the Glenside group. One catering and laundry department supplies all the different registrations. A maintenance team also works across the site. The group of homes is situated in the village of South Newton, on the A36, five miles north west of the city of Salisbury. A mainline train station is in Salisbury, the A36 is on a bus route and ample car parking is available on site. The home has a service users’ guide, which is offered to all prospective service users and/or their supporters. The fees are £1325 to £1550 per week. Extra charges include hairdressing, chiropody and sundries, such as toiletries. Grovely House DS0000047627.V329406.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The judgements contained in this report have been made from evidence gathered during the inspection, which included visits to the service and takes into account the views and experiences of people using the service. As part of this inspection, 14 questionnaires were sent out to service users and their supporters and 7 were returned. Comments made by residents and their relatives either in questionnaires or during the inspection, have been included when drawing up the report. The home also provided information requested by the CSCI prior to the inspection, relating to a wide range of matters, to inform the inspection. As Grovely is part of a campus which includes several registrations, the inspection took place over parts of three days. On Tuesday 13th March 2007 between 9:4am and 1:10pm, when the home itself was visited, on Wednesday 14th March 2007 between 9:45am and 1:45pm, when whole site services were reviewed and on Thursday 22nd March 2007, between 10:00am and 12:45pm when the Inspectors fed back and held discussions with the managers of the services. The first site visit was unannounced and took place at the same time as another Inspector visited a different registration on the campus. Mrs Vince, the home manager was on duty for the visit to the home on 13th March 2007. During the site visits, the Inspector met with four service users who were in the home at the time of the inspection. The Inspector reviewed documentation in detail for three of the residents whom she had met with. The Inspector also met with the home manager, two care staff, a catering assistant, two laundresses, a maintenance man, the training manager, the human resources manager and a finance manager. The inspector toured all the building and discussed facilities and arrangements with the manager, care staff and service users. Systems for administration of medicines and the clinical room were inspected. Financial records relating to two service users were reviewed. A range of records were reviewed, including staff training records, staff employment records and maintenance records. What the service does well: Grovely provides extensive, individualised rehabilitation to persons who have had a brain injury. Staff are trained in the area and have support from a wide range of therapists, who also work on site. All persons spoken with commented on how well all the multi-professional teams worked together, to develop and support service users in achieving as much independence as possible. Service users and their supporters are fully involved in setting their own individual goals. Individualised care plans are then developed from goals. These set out how the person’s goal is to be achieved. The effectiveness of such programmes was demonstrated by the fact that four of the service users Grovely House DS0000047627.V329406.R01.S.doc Version 5.2 Page 6 currently in the home had been supported in developing to the extent that they would be able to be discharged home in the near future. Staff spoken with all knew their service user’s needs in detail and reported that they felt fully supported by the home’s senior managers and training programmes. Staff spoken with also showed a detailed awareness of the need to safeguard vulnerable adults and how they were to be protected. Service users and their supporters commented on the home. One reported. “The staff are helpful, easy to get on with”, another person reported “Excellent staff, always sympathetic and caring as well as encouraging” and another person commented on how good the night staff were, describing them as “down to earth”. The building is compact and homely, with a non-institutional, relaxed atmosphere. During the inspection, music was heard coming loudly from one service user’s room. One service user reported, “ I love my room it’s the biggest in the house.” What has improved since the last inspection? What they could do better: Seven requirements, two of which relate to whole site matters and seven good practice recommendations, four of which relate to whole site issues, were identified at this inspection. Two issues related to service user care plans. Where service users are prescribed a medication on an “as required” (prn) basis, a care plan must always be drawn up to direct staff on the indicators for the use of such medication. Documentation relating to management of service users’ needs should avoid the use of general terms such as “normal” and state aims of care in a measurable form. Other issues related to management of service users’ moneys. Systems must be put in place, which all staff comply with, to ensure that service users’ moneys are managed in a safe manner and full records maintained. Where staff have a responsibility for directly handling service users’ moneys, their responsibilities for this should be included in their job descriptions. Staff who handle service users’ moneys, including agency staff, should be trained in safe Grovely House DS0000047627.V329406.R01.S.doc Version 5.2 Page 7 systems for management of service users’ moneys and legal issues which they may need to be made aware of. A few issues related to the home environment. A new microwave must be provided, as the current one has deteriorated to the extent where it will not be possible to clean it properly. A door bell should be provided for the service user’s flat. Suitable cleaning implements must be provided to ensure that the areas between the washing machines are clean and free of dust and debris. Used laundry must never be sorted on the floor as in a multi-occupancy house, this can lead to cross infection risk. Issues relating to the safe management of laundry and potentially infected laundry, should be included in service user rehabilitation programmes. Some issues related to staff recruitment and training. Where staff from agencies are employed, the home must be able to verify that they have had all required pre-employment checks, prior to being placed unsupervised with a service user. Management training should be provided to all persons who are in charge of a shift of duty. Staff who work on night duty should be provided with fire safety training four times a year. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Grovely House DS0000047627.V329406.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Grovely House DS0000047627.V329406.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2&3 Quality in this outcome area is good This judgement has been made using available evidence, including a visit to this service. All service users have a full and detailed assessment of their needs prior to admission. Service users are fully involved in the decision about admission to the home. EVIDENCE: Some service users reported that they had previously been cared for at the Assessment and Rehabilitation Centre (the ARC), which is also on site, and had moved to Grovely once they had progressed to the extent where they could manage in a less clinical environment. Others had come from placements outside. Of the six persons who responded to the pre-inspection questionnaire, five reported that they had been asked if they wanted to move into Grovely. Service users who had been cared for on the ARC said that they knew about Grovely because of being on the same campus, that they had been able to come over to Grovely and visit prior to deciding to transfer and had also met some of the Grovely residents, who were attending therapies on the ARC, and had heard about it then. One service user who had come from outside reported that their social worker had told them about Grovely and had given them information about what it could offer them. They had then visited Grovely House DS0000047627.V329406.R01.S.doc Version 5.2 Page 10 Grovely with their social worker and been able to see for themselves what it had to offer, before deciding if it would meet their needs. All service users had very detailed assessments of their needs prior to admission. All assessments detailed the individual rehabilitation goal for that person. Assessments were completed by a range of staff, including therapists, depending on each service user’s presenting need(s). Records relating to service users’ admissions were very detailed and enabled staff to prepare to meet a prospective service user’s needs prior to admission. Assessments were written in an approachable style, so that all persons who would be involved in providing services or therapies to the service user would be fully aware of their individual needs and how they were to be met. One carer reported that, where applicable, service users’ families were also closely involved in decisions about admission. The home cares for one service user who was admitted from another unit on site, whose prime needs did not relate specifically to rehabilitation and while it is appreciated that the service users’ needs could not be met in the other unit, as their placement in Grovely did not specifically relate to rehabilitation, although they did have needs relating to brain injury, their placement was not ideal. This person was due to go back to their home shortly. Mrs Vince reported that this experience would help her in her skills in negotiating with other services on site about admissions in the future, so that all persons were admitted for rehabilitation. Grovely House DS0000047627.V329406.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is excellent This judgement has been made using available evidence, including a visit to this service. Service users have full goals drawn up for their rehabilitation, which they and all relevant persons from the multi-disciplinary team are involved with. Service users are supported while they are in Grovely to make increasingly independent decisions about how they want to lead their lives. Service users are helped to become aware of risks and how to prevent risk to themselves, as presented by the outside environment. EVIDENCE: All service users have full and detailed goals set relating to their own aims for rehabilitation. Service users spoken with reported that they had been fully involved in setting their own goals, together with members of the multitherapeutic team and relatives, where relevant. All matters are documented in detail and signed by all relevant parties, including the service user. One described the therapists as “helpful”, another described how they had regular reviews with their occupational therapist. One person reported that they had Grovely House DS0000047627.V329406.R01.S.doc Version 5.2 Page 12 now developed their rehabilitation programme to the extent where they could take the bus on their own and to meet a therapist in town. Another service user reported on how they were learning to cook their own meals again. The whole aim and ethos of Grovely is about supporting service users in making decisions about their lives, so that they can live as independent a life as possible in the future. Service users have been supported in re-learning a range of skills that they will need to lead an independent life in the future. For example this may relate to provision of relevant aids such as wheelchairs or walking aids, to re-skilling the service user in handling money and buying things for themselves or in how to interact with and relate to other persons on a social basis. All service users are given a daily routine and/or weekly timetable, relating to their rehabilitation programme, which they agree to. Most service users responded in their questionnaires to report that they could choose how they spent their days, although several qualified this by reporting that they also had to attend their therapeutic programmes. As part of the rehabilitation programmes for individual service users, risk assessments are made of all matters relating to them and care plans developed to re-skill them in risk assessment. For some service users, this may relate to learning how to use public transport independently, to others how to manage making a snack or meal, to others how to manage their continuing healthcare needs in a responsible fashion. Grovely has a small flat attached to the building but with a separate entrance. Here service users can experience living on their own for a period of time before they go home. One service user said that this had been very useful for them, to assist them in knowing what they could and could not do and to be aware of things that they needed to know about when they left, such as always remembering to lock their front door. Several of the service users continued to wish to smoke. Where they wished to do so, a full individualised risk assessment was drawn up, which they agreed to. Grovely House DS0000047627.V329406.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, & 17 Quality in this outcome area is excellent This judgement has been made using available evidence, including a visit to this service. Service users are able to take part in a range of activities relating to their needs. Service users are supported as part of their rehabilitation programmes in how to use community resources. As part of each service users’ rehabilitation plan, they are helped to develop social skills. Service users rights and responsibilities as individuals are respected. Service users are offered a healthy diet. EVIDENCE: As Grovely is a rehabilitation unit for persons following brain injury, the whole ethos of the home relates to re-establishing each service user’s skills. This means that during the working week, each service user has a programme of therapeutic activities which they have agreed to be involved in. As with usual working life, leisure time is largely in the evenings and at weekends. Some service users go home at weekends. Several go out of the home to Salisbury Grovely House DS0000047627.V329406.R01.S.doc Version 5.2 Page 14 on Saturday, with appropriate support. One service user described how they were going out into town most weekends and were planning for their independence. Service users reported that evenings varied. Some people who had not been in the home for long said that they tended still to feel tired and want to just relax in the evenings, others were more active. One service user did report that the evenings could be “a bit boring”. There are two dogs in a kennel at the back of Grovely and one service user said that they enjoyed going out and walking them. Staff and service users reported that the most popular activity in the evening was a visit to the local pub, which is close to the entrance of the Glenside campus. As Grovely is not to be a service user’s permanent residence, involvement in the local community relates to their individual needs and aims for rehabilitation. Service users are encouraged to use outside community resources. For example, one service user was visiting a local dentist on the day of the inspection. Two other service users were going out with supporters at the weekend to Salisbury to get used to shopping for themselves. The Glenside campus also supports service users in developing a community on the campus. For example several service users commented on a recent darts match with service users living on Newlands, another registration on site. As service users are undergoing rehabilitation following a brain injury, family members and friends are regarded as very important in their rehabilitation programme. Significant relatives are often closely involved with therapists and staff in goal setting. Many service users go out for extended periods away from the home with their families as part of the rehabilitation programme, if that is what suits their needs. Psychologists are closely involved in developing rehabilitation programmes, supporting service users in re-gaining appropriate social skills to support them in their existing relationships and developing future relationships. Where behaviours, such as rudeness or swearing are exhibited by service users, this is documented and relevant actions taken to support service users, in using more appropriate behaviours in their social interactions. Staff spoken with clearly respected service users’ rights and supported them in developing an appreciation of their own rights. One staff member spoke, for example, about the balance between a service user’s rights to decide not to wash on the frequency that would be expected and the importance of ensuring that they remained acceptable within the community. She showed a very keen understanding of how complex such a balance could be for different individuals. Service users are also supported in being responsible to each other, learning for example, how to manage anger management problems, so that they do not affect other people in Grovely. The menus across site have recently been reviewed, with the aim of providing a varied choice for the wide range of people living there. Service users spoken with were complimentary about the meals offered. One reported that the food Grovely House DS0000047627.V329406.R01.S.doc Version 5.2 Page 15 was “very, very good, there’s lots of choice and plenty of it.” Another said that they would appreciate more low fat choices but that they felt that on the whole they got a “good choice every day”. Grovely House DS0000047627.V329406.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good This judgement has been made using available evidence, including a visit to this service. Service users receive the personal support that they need, in accordance with their written rehabilitation programme. Service users’ healthcare needs are met. There are safe systems for administration of medication and service users are supported in self-medicating, however care planning in one area needs to be further developed. EVIDENCE: Much of the ethos of Grovely is about helping service users to re-learn selfcare skills, so as much as possible, care staff follow programmes, some of which have been developed by therapists, to support service users in performing their own care. For example one service user had a very detailed care plan about the application of a splint to support a limb when they were in bed at night. Records clearly showed that staff were complying with this care plan. Care staff spoken with were very aware of each individual’s programme and how they were progressing, to ensure that they provided a range personal care to the different service users, in the way that they needed as individuals. Grovely House DS0000047627.V329406.R01.S.doc Version 5.2 Page 17 Some of the service users have significant healthcare needs following their brain injury and may need close monitoring. Where service users needed medical conditions monitoring regularly, care plans were in place relating to this. The care plan for one service user stated that a certain health care need was to be kept within “normal” limits, with no definition of what these normal limits were. It is advisable that words such as “normal” are avoided and precise, measurable wording is used, to fully direct staff. Many of the service users are regularly monitored and re-assessed by the range of therapists on site, including physiotherapists, occupational therapists, speech and language therapists and psychologists. Care staff reported that they worked closely with all the multidisciplinary team and felt able to bring up matters relating to service users, which they had observed, or service users had reported and that they would be listened to and action taken. One service user’s records showed that issues in relation to their physiotherapy programme had been identified by care staff, that this had been referred back to the physiotherapist and their programme altered to assist the service user. For another service user, care staff had documented that they had noted some swallowing difficulties, records showed that this had been reported promptly to the speech and language therapist and appropriate interventions put in place to support the service user. Records showed that service users were regularly monitored by local GPs and that consultant advice, for example psychiatrists, was sought when indicated. As part of rehabilitation programmes, service users are enabled to selfmedicate, as they become ready to do so. There is an agreed protocol in place for self-medication, using a four-staged approach, so that service users move to gradual increased independence with their medication, as they become more able to do so. At the time of the inspection, two service users were fully or partially self-medicating. Full records and assessment were maintained relating to this. Staff who administer medication all attend courses prior to taking on responsibility for medicines administration. All medicines were securely stored and there were full records of medicines received into the home, given to service users and disposed of from the home. Systems for administration of medicines were regularly audited by the supplying pharmacist. Some service users were prescribed drugs to be taken on an “as required” (prn) basis. Where this is the case, care plans need to be developed to direct staff on when these drugs are to be given to meet the service user’s needs and to assist staff in advising the prescriber of the effectiveness of such medications. Service user’s medications were regularly reviewed and drug use lowered where possible. One carer described the improvement in one service user since their admission, now that their mood-altering drugs had been reduced. Grovely House DS0000047627.V329406.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good This judgement has been made using available evidence, including a visit to this service. Grovely has systems in place to ensure that service users feel their views are listened to and acted upon. There are policies and procedures to ensure that this very vulnerable group are protected from abuse, however service users could be put at risk by unclear practice of procedures in relation to handling some of their money. EVIDENCE: The Glenside Group has a complaints policy, which includes all registrations on site. Each home keeps its own complaints file, on which compliments and verbal concerns, as well as written complaints are documented. The registered manager and staff spoken with were fully aware of the operation of this procedure. The complaints file showed that all issues of concern to service users and supporters were documented. For example, one service user had reported that they felt that they were not getting enough rehabilitation. The file showed that this had been investigated amongst the multi-professional team and the service user’s programme revised, and that they were also given more support in understanding their own programme. No formal complaints had been received since the previous inspection. All six of the service users who responded to questionnaires reported that they knew how to take a complaint. One reported “I have no complaints to make but I know that the staff could advise me on how to do this if needed.” Another reported that they would bring any matter up with the “Home manager or Deputy or my Key worker” Grovely House DS0000047627.V329406.R01.S.doc Version 5.2 Page 19 The Glenside Group have a very clear policy and procedure relating to vulnerable adults. One matter had been referred by the home in support of a vulnerable adult since the previous inspection. Detailed discussions took place at the time between Mr Norman, the Responsible Individual and other managers from the Group and other relevant parties. Appropriate action was taken to ensure the safety of vulnerable persons. Staff at all levels spoken with were very aware of their responsibilities for safeguarding adults, across a range of areas, relating to the service user, both as an individual and generally. For example one care reported on how they were aware that as part of a brain injury, service users could become sexually disinhibited or have problems with anger management, they were aware of actions to take to ensure service users’ safety in such situations and whom to refer relevant matters on to. Staff spoken with were also fully aware to the Glenside Group’s whistleblowing policy and how to work within it. Training in safeguarding adults involved taught sessions, discussions and question and answer sessions. This training is offered regularly by the training department and all staff are required to attend annual up-dates. Grovely looks after service user’s day-to-day moneys as part of their rehabilitation programmes. In order to assist service users and supporters, some service users may have several different accounts going at the same time. A spot check of four accounts for one person and two accounts for another showed that the moneys held did not agree with the records on two occasions. On both of these, the amount of moneys was more than on the account record. The manager had last checked the moneys on the Friday before the inspection, and they were correct at that time. It appeared on discussion that a range of persons, not just home staff have access to service users’ moneys. This is an area which needs attention and roles and responsibilities for handling money and documenting moneys need to be clarified. It is also advisable that responsibilities for handling moneys be included in job descriptions for all relevant persons and that the area, including legal responsibilities, is included in induction and training programmes. All service users also have an identified external person who manages moneys on their behalf. These persons were invoiced for other sundries, such as chiropody, on a quarterly basis. Full records of charges and payments were maintained. Grovely House DS0000047627.V329406.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 29 & 30 Quality in this outcome area is good This judgement has been made using available evidence, including a visit to this service. Grovely presents a homely, comfortable environment for service users to live in. Most areas are well maintained and clean, although attention is needed to one piece of equipment, equipment shared across campus and practice relating to laundry. A wide range of therapeutic aids and equipment is provided to meet residents’ disability needs. EVIDENCE: Grovely is a two-story domestic-style dwelling. Bedrooms are provided on the ground and first floors, with a separate one bedroom flat to one side of the building, with its own separate entrance. The home is largely well maintained, particularly considering the complexities presented by the client group (see below). Regular up-grading takes place, for example, work has recently been completed to the assisted bathroom on the ground floor to make it more useable for service users and staff. There is a large homely kitchen/diner and separate lounge on the ground floor. At the back of the building, there is an Grovely House DS0000047627.V329406.R01.S.doc Version 5.2 Page 21 activities area, which is temporarily being used as a day centre, while facilities are being built on site. There is also a separate smoking room. The home has patios at the back and front, which are ramped and wheelchair accessible. The patios are free from tripping hazards. The home was clean throughout. One relative described Grovely as “a warm, clean, safe environment.” A few areas needed attention, the microwave in the kitchen, which was often used by service users, had rusted in places, with the under surface showing under the turntable. As such it would not be possible to keep it clean, so it needs to be replaced. The home has a small laundry and service users, as part of their rehabilitation programmes, are supported in learning how to perform their own laundry. When the laundry was visited, one service user had left their used laundry piled up on the floor, in front of the machine. As one of the service users was known to have an infection, this practice could present a risk to cross-infection. Service users are trained in kitchen hygiene as part of their rehabilitation programmes and it is also advisable that they be advised of safe handling of laundry in communal settings. The service user living in the flat kept the door to the flat locked, as would be expected, and staff knocked on the door when they wanted to come in. In order to foster a more domestic atmosphere, a door bell should be installed, as would be in place in any domestic dwelling. As service users are undertaking rehabilitation programmes, a wide range of equipment is provided to meet their therapeutic needs. One service user met with had a wheelchair which had been supplied to them to meet their particular individual mobility needs. These are regularly evaluated. Staff have been trained in the use of a wide range of aids and there are clear care plans relating to aids. Staff also showed understanding when service users had difficulty in managing a particular aid. For example one service user found managing their mobility aid complex, due to additional perceptual and behavioural problems. As a result, some parts of the décor in certain areas of the home had been affected. Staff had ensured that areas affected had been cleared as much as possible and had plans in place with the maintenance team for areas to be addressed when the service user was discharged, which was to take place shortly. A weighing scales suitable for wheelchair users is provided across the campus, for use by all homes on site. Discussions with the maintenance department also indicated that while industrial carpet cleaners were available, there were not enough for each registration. Joint use of equipment across the campus needs to be reviewed, as while it is appreciated that sharing of equipment between units may be necessary, such sharing may also involve a range of risks to health and safety and spread of infection. These need to be fully considered. A central laundry performs non-domestic laundry, such as bed linen. There are procedures for the management of infected and potentially infected laundry, which laundresses report staff keep to. The washing machines and dryers are regularly serviced. The area behind the machines Grovely House DS0000047627.V329406.R01.S.doc Version 5.2 Page 22 was clean and dust-free. One of the laundresses reported on how they were small enough to climb behind the machines to clean the area. The area between the washing machines showed significant deposits of dust. The laundresses reported that this was because they did not have any implements to clean these narrow areas. Deposits of dust in a laundry present a significant risk to cross infection, as micro organisms can live in dust in the warm, dry atmosphere of a laundry for extended periods of time. Correct implements need to be provided to enable full cleaning between the machines. Grovely House DS0000047627.V329406.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 & 36 Quality in this outcome area is good This judgement has been made using available evidence, including a visit to this service. Service users are supported by competent and qualified staff. The systems for recruitment of staff generally protects service users, apart from where agency staff have been supplied to support individual service users. Service users are protected by the extensive staff training programmes. Staff are fully supported and supervised in their roles. EVIDENCE: Grovely is staffed by a team of care assistants, led by a manager. A team leader is on duty for every shift. A review of the home’s roster showed that there is a low turnover in staffing. Some of the staff have worked in the home or the Group for many years. Many staff were very loyal and were prepared to cover for unplanned absences. Agency staff are not used in care. As well as nursing and care staff, the home are supported by central staff services, including maintenance, catering, laundry and therapy staff, as well as site management, administration and training. Grovely House DS0000047627.V329406.R01.S.doc Version 5.2 Page 24 Staff have been trained in a wide range of skills to meet service user needs. The Glenside Group has a training department, which is managed by a qualified trainer. All staff, at all levels, undergo a standard induction programme when they take up their posts. This includes all relevant areas such as manual handling, health and safety, fire safety and infection control. Newly employed staff are issued with a standard induction booklet, which they and their trainer/mentor sign, once they have been fully inducted into each area. One carer said that they had been impressed by their induction, which they described as “wide ranging”. The Glenside Group supports NVQ training and approximately 80 of care staff are trained to NVQ 2 or above. Staff who work in the brain injury service receive additional training in the area, to enable them to fully support service users and be aware of the range of service user need and therapies involved. All staff also undergo annual resuscitation training. Additional training to meet service user needs also is provided in a range of other areas, for example prevention of pressure damage and diabetic care. Home managers are responsible for ensuring that their staff receive mandatory training. Information is freely available in each registration to show which members of staff need to attend which training. Staff spoken with reported that the Glenside Group fully supported them in training, one carer reported that “they are very good in that area”. Staff spoken with showed a detailed knowledge of the needs of persons with a head injury and all knew of actions to take in the event of a medical emergency, such as sudden collapse. The Glenside Group has a central human resources (personnel) department, which handles all applications for employment. Much improvement has been made since the previous inspection in a range of areas relating to employment of staff. All staff have a criminal records check and are checked against the vulnerable adults list. If positive results are identified, their suitability for their role is assessed and a risk assessment performed. All prospective staff complete an application form and health status questionnaire. At least two suitable references are now always obtained prior to employment. All staff are interviewed, using an interview assessment tool. These were fully completed on a individual basis. Mrs Vince reported that she had been involved in interviewing prospective members of staff. Staff files showed that there were systems for management of performance, including absences. Where issues were identified, these were followed up with the individual staff member. As a recent innovation, service users who are due to go home, have had “buddies” assigned to them, who will work with them and then carry on supporting them when they go home. This had been arranged by the occupational therapy service. Two service users had been out at the weekend with their “buddies”. This was reported to be an effective way of supporting service users as they prepare for discharge. The home manager was aware that an agency was being used to supply these persons, but was not aware of how they had been recruited by the agency. The human resources director was not aware that these people were working with service users and by the time of the third site visit, she was seeking information on the status of the Grovely House DS0000047627.V329406.R01.S.doc Version 5.2 Page 25 agency and whether the agency workers had had all the required preemployment checks. She reported that she will remind all personnel that she must be informed of the use of such staff, so that she can ensure that all preemployment checks have been correctly performed. The Glenside Group has a clear system for regular staff supervision. All staff spoken with confirmed that they had received supervision at least every six weeks and an annual appraisal. Records relating to supervision and appraisal were seen on staff files. Supervisions and appraisals were individual in tone and issues relating to training and development were consistently included. Records showed that supervisions were also performed when it was considered that a member of staff needed additional support in a particular area. Supervision and appraisal records cross-referenced to training records, so that it was clear that where a member of staff has requested, or was assessed as needing training in a particular area, arrangements had been made for the person to attend training in a timely manner. Grovely House DS0000047627.V329406.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Quality in this outcome area is good This judgement has been made using available evidence, including a visit to this service. Grovely is a well run home. Quality of service provision is regularly reviewed by the Group’s management team. The health, safety and welfare of service users is promoted and protected. EVIDENCE: Mrs Vince has been approved as registered manager since the previous inspection. She was the deputy manager previously. She holds the managers’ award and reported that she is now considering working towards an NVQ4 in care. She reported that she had had a full induction into her role, when she became manager. She also showed a full understanding of her role in relation to the Care Standards Act. The results of this inspection showed that she had made developments across a range of areas relating to service user Grovely House DS0000047627.V329406.R01.S.doc Version 5.2 Page 27 rehabilitation and care. It also shows that she works well with other managers on site and professionals, such as therapy staff. Mrs Vince is supported by a deputy and team leaders as well as care staff. Evidence from this inspection shows that Mrs Vince has supported her staff, ensuring they work as an effective team. The Glenside Group has a team of senior managers who work an on-call rota to support all the registrations on site. When the manager or her deputy are not on duty, there is always a senior carer to take charge of the home. In discussion with the training manger, it appears that persons who may be in charge of the home are not regularly trained in this role or their responsibilities. This is indicated, so that such persons can properly support the manager and do not need to call for assistance from the senior management team, unless indicated. The owners of the home have a system for reviewing quality of care on a regular basis. The documents reviewed considered a range of indicators in a detailed manner. The documents do not seek to “sell” the service, but detail good points and the areas which need to be addressed, including action plans and timescales. One outcome from quality audits for example, was that the menus have been reviewed and new menus put in place, to suit the range of services provided on site. The Glenside Group has systems to ensure that staff are trained as required in a range of matters relating to health and safety. A recent fire safety audit had taken place across services on site. At present night staff are trained in fire safety twice a year. The home are advised that, as fire officers consider the risk to service users at night, when there are fewer staff, to be higher, that all staff who work nights need to be trained in fire safety four times a year. A review of maintenance records and discussions with the maintenance manager showed that other areas relating to health and safety, such as lift, hoist and boiler servicing, fire safety checks and water temperature testing takes place at the regularity advised. Grovely House DS0000047627.V329406.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 x 2 4 3 3 4 x 5 x x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 4 30 2 STAFFING Standard No Score 31 x 32 4 33 x 34 2 35 4 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 x 4 x LIFESTYLES Standard No Score 11 x 12 3 13 4 14 x 15 4 16 4 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 4 2 x 3 x 4 x x 3 x Grovely House DS0000047627.V329406.R01.S.doc Version 5.2 Page 29 NO 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 YA20 Regulation 13(2) 15(1) Requirement Where service users are prescribed a medication on an “as required” (prn) basis, a care plan must always be drawn up to direct staff on the indicators for the use of such medication Systems must be put in place, which all staff comply with, to ensure that service users’ moneys are managed in a safe manner and full records maintained. A policy and procedure on equipment shared across the site must be put in place to ensure that adequate equipment is provided. This must conform to health and safety and infection control guidelines. A new microwave must be provided. Suitable cleaning implements must be provided to ensure that the areas between the washing machines are clean and free of dust and debris. Laundry must never be sorted on the floor. Where staff from agencies are employed, the home must be DS0000047627.V329406.R01.S.doc Timescale for action 31/05/07 2. YA23 17(2) Sc4(9) 30/04/07 3. YA30 23(2)(n) 30/06/07 4. 5. YA30 YA30 23(2)(c) 13(3) 31/05/07 31/05/07 6. 7. YA30 YA34 13(3) 19(4) 30/04/07 31/05/07 Grovely House Version 5.2 Page 30 able to verify that they have had all required pre-employment checks, prior to being placed unsupervised with a service user. 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. Refer to Standard YA18 YA23 YA23 Good Practice Recommendations Documentation relating to management of service users’ needs should avoid the use of general terms such as “normal” and state aims of care in a measurable form. Where staff have a responsibility for directly handling service users’ moneys, their responsibilities for this should be included in their job descriptions. Staff who handle service users’ moneys, including agency staff, should be trained in safe systems for management of service users’ moneys and legal issues which they may need to be made aware of. A door bell should be provided for the service user’s flat. Issues relating to the safe management of laundry and potentially infected laundry, should be included in service user rehabilitation programmes. Management training should be provided to all persons who are in charge of a shift of duty. Staff who work on night duty should be provided with fire safety training four times a year. 4. 5. 6. 7. YA24 YA30 YA37 YA42 Grovely House DS0000047627.V329406.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB 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 Grovely House DS0000047627.V329406.R01.S.doc Version 5.2 Page 32 - 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!