Inspection on 05/11/07 for The Grand Panorama

This inspection was carried out on 5th November 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

The Grand Panorama 30/09/08

The Grand Panorama 17/01/06

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE The Grand Panorama 57 South Road Weston Super Mare North Somerset BS23 2LU Lead Inspector Melanie Edwards Key Unannounced Inspection 09:30 5th November 2007 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 The Grand Panorama DS0000065085.V344212.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. The Grand Panorama DS0000065085.V344212.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Grand Panorama Address 57 South Road Weston Super Mare North Somerset BS23 2LU 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) 01934 417791 Alutarius Ltd Mrs Catherine Mutongwizo Care Home 23 Category(ies) of Old age, not falling within any other category registration, with number (23) of places The Grand Panorama DS0000065085.V344212.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. May accommodate up to 23 people aged 65 years and over who may require nursing care. May also accommodate one person aged 50 years and over, who has a physical disability (subject to the inspectors agreement). May continue to accommodate those residents aged less than 65 years, who were placed prior to November 2005. The registered provider must provide CSCI with a detailed plan for refurbishment within three months of registration, to improve the quality of the accommodations, access arrangements and bathing facilities. Patients with mobility problems must not use those rooms accessed by steps. 23rd August 2006 2. 3. 4. Date of last inspection Brief Description of the Service: Grand Panorama is registered to provide nursing and personal care to up to 23 older people. The converted property is situated on the hillside above Weston Super Mare. Many rooms enjoy panoramic views over the town and the bay. There is a bus stop just outside the home, but a steep drive means that visitors with restricted mobility may find it difficult to reach the building. Internally, the home was in need of major redecoration and refurbishment. Mr and Mrs Coombes, trading as Alutarius Ltd bought Grand Panorama at the beginning of the year and work to improve the home has begun. The grounds are being tidied and trees planted along the driveway have been cut back to improve the outlook from the side of the home. The Grand Panorama DS0000065085.V344212.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was carried out over one day. The inspector met nine of eleven residents living at the Home. Mrs Teri Mutema the newly registered manager, two care assistants and the chef were consulted about roles, responsibilities, training needs, and how they assist residents. Staff were observed assisting residents with their needs. The lunchtime meal was observed being served. A number of records relating to the running and management of the Home were looked at. A number of resident’s care records and care plans were checked and inspected. The majority of the environment was seen and the only areas that were not checked were a small number of bedrooms. Mrs Mutema completed The ‘AQAA’ (an annual quality assessment document that all Homes are required to use). The Home was operating within the required conditions of registration set down by the Commission. The conditions of registration detail the type of care and the needs of residents, and the numbers of residents who may stay at the Home. What the service does well: Residents expressed very positive views of the staff and service at the Home. Examples of comments made by residents and family included, `All the staff look after me well and the chefs will always cook me what I want. I don’t think they need to improve’, `the staff are all very kind caring friendly and obliging ’, `I am very happy with all the things the home does for me I also enjoy the food, I am happy with the home I don’t think they need to improve ’, and `they attend to each persons need with care and patience and are all friendly and do their up most to put everyone at ease ’. Residents are cared for by kind and caring staff who work hard trying to meet their needs. The Grand Panorama DS0000065085.V344212.R01.S.doc Version 5.2 Page 6 A range of low-key social and therapeutic activities are put on for residents. Residents are provided with a well-balanced nutritious diet. What has improved since the last inspection? 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. The Grand Panorama DS0000065085.V344212.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 The Grand Panorama DS0000065085.V344212.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): 1,3, 6. Quality in this outcome area is good. Residents’ needs are being assessed when they move in to the Home. Residents and their representatives are provided with information to make an informed choice about living at the Home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: To find out about the quality of information prospective residents and representatives are given about the Home a copy of the service users guide and the statement of purpose was read. Each resident is given their own copy of the guide so they have information about life in the Home. The service users guide and the statement of purpose include information about the service provided, the qualifications of the staff employed, and the accommodation. The philosophy of the Home and how the service aim to meet residents needs is included. The complaints procedure is in the document for residents to know how to complain about the service. There are pictures of the Home, included in the service users guide to help inform the The Grand Panorama DS0000065085.V344212.R01.S.doc Version 5.2 Page 9 reader about the service. The use of photographs gives the reader of the service users guide helpful information about the home and community. To see how residents’ care needs are being assessed by the Home, and how the care they need is planned, two assessment records were looked at in detail. An assessment of both residents needs had been completed. The assessments included a range of helpful information about the resident’s care needs. There was a skin vulnerability assessment completed for both residents. The assessments show that the residents’ risk of developing pressure sores has been assessed. There was also an assessment carried out of the risk of the person falling, and what action should be taken to minimize the risks. The Grand Panorama DS0000065085.V344212.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): 7,9. Quality in this outcome area is adequate. Residents care plans partly demonstrate how residents’ needs are met Residents’ medicines are stored securely and records show medicines are given as prescribed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Two residents care plans were reviewed to find out how residents care needs are met. The care plans contained information to show how to meet the residents’ physical, social, and communication and needs. However both care plans were not totally up to date. They needed updating to reflect the residents changing needs. Specifically one resident has been identified as experiencing anxiety and agitation however there was no care plan to show how to help the person with this .The second residents assessment record said they need one to one supervision .The residents care plans did not reflect what this means or how it would be achieved. The Grand Panorama DS0000065085.V344212.R01.S.doc Version 5.2 Page 11 The care plans seen had been reviewed and updated on a sufficiently regular basis. This shows residents care needs are being monitored and kept under review. The procedures and systems in place for administration, storage and disposal of medication were checked to monitor if the systems are safe. The Home has introduced a very detailed monthly self-audit of its own medication practises and procedures. Medicines are supplied by a local pharmacy. The medication administration charts of three residents were inspected. There was a photograph of the person maintained with each record. This should ensure medication is administered correctly to the person named on the chart. The administration charts were up to date, legible and in order. The staff had signed for medication administrated, or recorded the reasons for any omissions. The Grand Panorama DS0000065085.V344212.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): 12,13,15. Quality in this outcome area is good. Residents can take part in a variety of low-key social and therapeutic activities. Residents are offered a varied and nutritious diet. Residents can keep close contact with family and friends if they so wish. This judgement has been made using available evidence including a visit to this service. EVIDENCE: To support and encourage residents to take part in social and therapeutic activities an activities coordinator works for four days a week. There job is to engage residents in a variety of low-key social and therapeutic activities such as bingo, arts and crafts, baking, watching old films, trips to the town of Weston Super Mare to look at the sea front. Residents who stay in their rooms also have regular contact with the activities organiser. She reads to them and spends time talking to them. This shows how the needs of those residents are not forgotten. The Homes policy for residents to receiving visits is very relaxed and flexible. Residents were observed receiving visits from their families during the The Grand Panorama DS0000065085.V344212.R01.S.doc Version 5.2 Page 13 inspection. It also says in the service users guide that family and friends may be able to stay the night at the Home if required. To make sure residents are offered a choice of meals Staff ask residents on a daily basis what their preferred meal options choices are for the following day. There are also alternative meal options available if people do not like the main meal options, and special diets are catered for. The menu of residents’ meal choices was checked to see if residents get a varied well balanced diet. The menu was well balanced and varied. It was reported that residents are always able to chose an alterative dish .On the day of the inspection the main meal option was chicken pie mashed potatoes, fresh cabbage and carrots. There was a jam sponge and custard for desert, which was tasty and well presented. Residents did mostly comment positively about meals and said they thought the food they are offered was, `good’, `ok’, or `not too bad ’. The Grand Panorama DS0000065085.V344212.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. Residents’ complaints are listened to and acted upon wherever possible. There are staff training and procedures in place to help to protect residents from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A copy of the complaints procedure is on display in the entrance hall. This includes the name of the Commission for Social Care Inspection, for anyone who wishes to contact us. The contact details of the owners are included in the service users guide, and complaints procedure if residents wish to contact the owners directly. The complaints record was looked at and showed that there have been no complaints received since the last inspection. However complaints that had been dealt with before this time had been responded to promptly and thoroughly. The staff team have done training to help them understand issues around the protection of vulnerable adults from abuse. This helps to protect residents if staff have a good understanding of what abuse is, and how to stop it happening. There are procedures and guidance information on the topic of ‘ the protection of vulnerable adults from abuse ’. The Grand Panorama DS0000065085.V344212.R01.S.doc Version 5.2 Page 15 This helps to protect vulnerable adults who live at the Home, if staff have the necessary information to ensure their protection. The Grand Panorama DS0000065085.V344212.R01.S.doc Version 5.2 Page 16 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): 19,21,24,25,26.Quality in this outcome area is adequate. Residents live in an environment that is generally clean and satisfactorily maintained. However one area of the Home is not satisfactorily clean. The Home is generally suitable for residents to live in and has the necessary adaptations and equipment in place to meet residents’ needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Grand Panorama Care Home is a large property that was previously a Hotel. The Home is built over three floors. To get to these floors residents use stairs or a lift. The top floor known as the annex floor is accessible by stairs or a stair lift. The Home is a short car ride away from Weston Super Mare town Centre. There are local shops a library, a church, pubs, the sea front, and Weston Super Mare Hospital is nearby. The Grand Panorama DS0000065085.V344212.R01.S.doc Version 5.2 Page 17 There is a range of specialist equipment and adaptations in place throughout the Home, to assist people who may have reduced mobility. The main lounge and dining area and a number of bedrooms benefit from having a good view of the nearby sea. Several residents said they enjoy the view from their rooms. Residents were observed sitting in communal areas looking relaxed. The environment was mostly clean and tidy, however a bathroom on the middle floor had a very strong and unpleasant odour. Bedrooms and all the communal areas were viewed. Rooms were satisfactorily decorated and maintained. The environment was clean and tidy throughout. Bedrooms have been personalised to reflect the tastes of residents with photographs, mementos and small items of furniture. The standard of furniture and fittings is satisfactory. Domestic staff were observed working hard cleaning the Home. Grand Panorama is reached by a very steep drive and there is parking for two cars outside only. As was required at the last inspection there needs to be a plan set out for how to improve the accessibility of the Home. This relates to improve access for people with reduced mobility. The Grand Panorama DS0000065085.V344212.R01.S.doc Version 5.2 Page 18 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): 27,28,30.Quality in this outcome area is adequate. Residents’ are cared for by a sufficient number of staff that have done some training to meet their needs. However residents would benefit if Care staff undertook National Vocational Qualification in care award training. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The staff duty record for November 2007 for nursing and care staff was looked at to find out if residents benefit from a sufficient number of staff to meet their needs. For the current number of eleven residents there is a minimum of one registered nurse on duty at all times and two care assistants in the morning, with one registered nurse and two care assistants in the afternoon. At night there is one registered nurse and two care assistants on duty. Currently due to a shortfall in registered nurses Mrs Mutema is working shifts, and does not have any supernumerary management time for November. Mrs Mutema said that the Home is in the process of recruiting new registered nurses. This will be highly beneficial, and will also mean Mrs Mutema has more time to fulfil the requirements of the role of registered manager. There are also catering, domestic, and laundry staff employed, although the numbers of these staff were not reviewed. The training records of the staff team were looked at to see if registered nurses and care staff are keeping up to date with their knowledge of residents The Grand Panorama DS0000065085.V344212.R01.S.doc Version 5.2 Page 19 needs. There was evidence that demonstrated registered nurses had attended some clinical training sessions, and updating over the last twelve months. However it would be highly beneficial to residents if care staff the National Vocational Qualification in care award training. Currently only one care assistant is undertaking the award, and none of the other care staff have done this training. The Grand Panorama DS0000065085.V344212.R01.S.doc Version 5.2 Page 20 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): 31,33,37,38.Quality in this outcome area is adequate. Mrs Mutema is suitably qualified to run a care Home. The health and safety of residents is generally protected. Improvements need to be made to how the Home is monitored by the Company. This is in reference to a lack of Regulation 26 visit reports being available for inspection. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Mrs Mutema is a first level registered nurse in general nursing .She has many years of experience caring for people with a range of nursing needs. She has been the deputy manager of the Home. The Grand Panorama DS0000065085.V344212.R01.S.doc Version 5.2 Page 21 She has been registered with us in the last two weeks. This helps to demonstrate fitness to be in charge of a Care Home. The Company who run the Home has its own format for monitoring the quality of the care and the overall service. Mrs Mutema says she will be seeking the views of residents and relatives in a number of ways including the use of questionnaire forms. An action plan will then be devised to address any weaknesses in the Home. The process of Quality Monitoring in the Home may be reviewed in full at the next inspection The records of monthly Regulation 26 unannounced visits to the Home were not available. The Regulation 26 visits, and are evidence that residents have been interviewed by someone representing the company and also, that the care in the Home has been reviewed by them. It is a requirement that records of these visits are available for inspection. The environment looked safe and satisfactorily maintained in the areas viewed. Mrs Mutema said that bedside rails and air mattresses are checked on a regular basis to make sure they are safe. Staff do training in health and safety matters including first aid, food hygiene training and moving and handling practises. This should help protect residents’ health and safety if staff are knowledgeable and well trained in these health and safety principles and practices. However Staff needs to make sure they empty full commodes in the sluice and not down toilets. This is to make sure safe infection control procedures are followed. The fire logbook records showed fire alarm tests are being carried out. There are also fire drills carried out on a regular basis to help protect the health and safety of residents and staff. The kitchen was tidy and organised when viewed. Up to date checks of kitchen fridges and freezers are maintained, to ensure they are operating within food safety guidance levels. There were also records to demonstrate that `high risk’ foods are temperature probed before serving to ensure the food has reached above minimum required temperature. The Grand Panorama DS0000065085.V344212.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 3 10 X 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X 3 X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X X X 3 2 The Grand Panorama DS0000065085.V344212.R01.S.doc Version 5.2 Page 23 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard OP7 OP22 Regulation 15(1) 23 (2) Requirement Care plans must show how to support residents with their needs. Plans to improve the accessibility of the Home must be implemented. This is outstanding from the last two inspections. Action must be taken so that the bathroom identified is free from odour. The records of Regulation 26 visits must be available for inspection. Timescale for action 05/11/07 05/04/08 3. 4. OP19 OP33 16.2 (k) 26 05/11/07 19/11/07 The Grand Panorama DS0000065085.V344212.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. Refer to Standard OP28 Good Practice Recommendations There should be a programme of National Vocational Qualification in care award training set up for Care Staff. The Grand Panorama DS0000065085.V344212.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection South West Regional Office 4th Floor Colston 33 33 Colston Avenue Bristol BS1 4UA 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 The Grand Panorama DS0000065085.V344212.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. 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