Inspection on 02/02/06 for The Granleys

This inspection was carried out on 2nd February 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Granleys 30/01/08

The Granleys 22/08/07

The Granleys 25/08/06

The Granleys 05/07/05

The Granleys 05/03/05

The Granleys 17/06/04

The Granleys 02/02/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 The Granleys 21 Griffiths Avenue St Mark`s Cheltenham Glos GL51 6SJ Lead Inspector Mr Simon Massey Unannounced Inspection 2nd February 2006 09:30 The Granleys DS0000016610.V288851.R01.S.doc Version 5.1 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 Granleys DS0000016610.V288851.R01.S.doc Version 5.1 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. The Granleys DS0000016610.V288851.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service The Granleys Address 21 Griffiths Avenue St Mark`s Cheltenham Glos GL51 6SJ 01242 521721 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) Mrs Brenda Tapsell Miss Amy Clare Ranger Care Home 17 Category(ies) of Learning disability (17) registration, with number of places The Granleys DS0000016610.V288851.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. To accommodate 3 named service users who are over the age of 65yrs. This condition will be removed once the named service users no longer reside at the home. 5th July 2005 Date of last inspection Brief Description of the Service: The Granleys is a detached property approximately 1 mile from the centre of Cheltenham. The home provides care and accommodation to 17 adults with learning disiabilities.The house is set in large grounds and is a listed building. The accommodation is arranged over two floors and all of the rooms have ensuite facilities. The Granleys DS0000016610.V288851.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place on 2nd February 2006 over 4 hours and was conducted by Simon Massey and Tanya Harding. The inspectors met with the Registered Manager, the Registered Provider and a number of service users who were at home at the time of the visit. Records were examined relating to care planning, staff recruitment, maintenance and staff rotas. Certain parts of the environment were also inspected. The inspectors also focused on following up the requirements made as a result of the last inspection, which was undertaken on 5th July 2005. A subsequent visit was made to the home on 24/02/06 to assess compliance with two immediate requirements, which were made following this inspection. These requirements have been complied with. What the service does well: What has improved since the last inspection? The home now carries out risk assessments for any new staff if all the preemployment checks have not been received. The home has introduced a new format for care planning that if used correctly will meet the needs of the service users. Staffing levels have been increased at certain times during the week. The Granleys DS0000016610.V288851.R01.S.doc Version 5.1 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 Granleys DS0000016610.V288851.R01.S.doc Version 5.1 Page 7 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 The Granleys DS0000016610.V288851.R01.S.doc Version 5.1 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Assessments of new service users need to be completed in more detail to ensure that the care plans contain the information on how needs are going to be met within the home. EVIDENCE: Two service users have left the home since the last inspection. Three new service users have been admitted. There has been one emergency admission for reasons explained to the inspectors. The manager explained that she has obtained the necessary information about the person from Social Services and that a placement meeting has been arranged to take place later this month to assess how the service user has settled in. File for a new service user was viewed. The manager has completed a preadmission assessment. This had a number of gaps where key information has not been completed. This included information about the person’s benefits, likes and dislikes, future needs, personal preferences and concerns about the future. A needs assessment for the same person completed by the sponsoring authority stated a number of needs which were not evident in the care guidance developed for this service user by the home. For example the information about the person’s personal care has not been incorporated into The Granleys DS0000016610.V288851.R01.S.doc Version 5.1 Page 9 the care plans and it was not clear how staff would support the service user with this. There were a number of other needs which did not have corresponding care plans. These deficiencies in care planning must be addressed. The Granleys DS0000016610.V288851.R01.S.doc Version 5.1 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6&9 The content contained in the new care planning format needs to be further improved to ensure that sufficient detail is included on how needs are going to be met. Further evidence is required to demonstrate that the home has “person centred” approach to care planning. EVIDENCE: The home has obtained a person centred pro-forma for all service users. This is so that information can be collated about the holistic needs of each person. The manager explained that she has started to complete these. One book was examined. The information seen did not reflect a person centred approach and this was highlighted to the manager and the proprietor. For example the section about medication for one person simply duplicated the information already held and made no reference to what strategies will be put in place to support the service user to be more involved in the process. The value of person centred approach is about focusing on the individual and identifying ways in which the person can exercise control. It is felt that this important aspect of the process is being missed. The Granleys DS0000016610.V288851.R01.S.doc Version 5.1 Page 11 Care plans written for a new service user were very brief and did not cover the person’s needs holistically. It was noted that photographs have not been obtained for all of the service users and this must be addressed urgently. Many of the service users have been assessed to be vulnerable in the community as reflected in care plans. A missing persons sheet was seen on two files. Other files examined did not have this. The home must develop missing persons information for all service users. This needs to be easily accessible and suitably detailed. Risk assessments seen were still very brief. There is an indication of severity and likelihood of risk occurring, although it is not clear how this has been evaluated. The home has developed guidance around staff expenses for meals out. This shows that service users have to meet the costs incurred by staff. Further discussion about this issue is likely at future inspections. As a follow up to the requirement made in the last report about better recording around service users expenditure records the manager advised that improvements have been made and all receipts are recorded and assigned correctly. This will be revisited in future visits. The Granleys DS0000016610.V288851.R01.S.doc Version 5.1 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 15 Service users are supported to maintain family contacts but better efforts could be made to support people to see and visit their friends. EVIDENCE: Three service users were involved in food preparation on the day of the visit, making a cake. Service users confirmed that they were enjoying this activity. One person has an identified wish recorded in their file to maintain contact and friendships with two specific people outside of the home. However, there are no care plans in place to say how these relationships will be supported. Daily records seen for the service user showed that there has been no contact or visits made since the person had moved into the home. There was evidence of service users having contact with friends and families, with people visiting the home and service users being supported to make home visits. The Granleys DS0000016610.V288851.R01.S.doc Version 5.1 Page 13 The home has a policy in place for staff in relation to the expenses for meals out and the contributions that must be made by service users. The Granleys DS0000016610.V288851.R01.S.doc Version 5.1 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 & 20 Errors in medication administration could affect the welfare of the service users. EVIDENCE: One person has a recurrent health need that affects their continence. No care plan was evident on file about how the person would be supported in this area. Medication administration sheet was examined for one service user. The following shortfalls were noted and must be addressed. 1. The MAR chart had a number of gaps in signatures, where it was not clear whether the medication has been administered or not. 2. Medication administration information for one person stated that they needed to be given one or two tablets every day. There was evidence that the person was being administered two tablets daily. The manager must clarify with the person’s GP: a) what is the accepted dosage and agreed daily dose and b) whether this medication is ‘as required’, in which case there needs to be a clear protocol supporting this. One service user has been prescribed medication to manage their behaviours. The manager explained that this is because the person has been more challenging and aggressive. However, this was not seen to be reflected in the The Granleys DS0000016610.V288851.R01.S.doc Version 5.1 Page 15 person’s notes. Daily records for October, November and December 2005 were examined and showed that the service user has been “fine and in a good mood” with no indication of any difficulties or behaviours which can be seen as challenging. Records were seen on file about medical treatment provided for one service user during last year. The home has kept the Commission informed of these matters. Weight records are maintained and there was evidence on the whole of regular monitoring. However, for one person who has suffered ill health and has lost a considerable amount of weight the monitoring could have been better. The person was weighed in April 2005 and then not until January 2006. The Granleys DS0000016610.V288851.R01.S.doc Version 5.1 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not inspected during this visit. EVIDENCE: The Granleys DS0000016610.V288851.R01.S.doc Version 5.1 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 There are shortfalls in the monitoring and organising of repairs, which is creating hazards in the environment and potentially putting the service users at risk. EVIDENCE: A brief inspection of some of the bedrooms was carried out. It was noted that one fire door was not closing properly. The door handle was loose on the same door. In room 14 there was a light fitting which did not appear safe and an immediate requirement was issued to remove the fitting. This has now been done. In another bedroom a nail was sticking out of the floor and the service user said they had hurt their foot on this. An immediate requirement was issued to the home to ensure the nail was made safe. This was later checked by the inspectors who found that although the nail had been sorted out, there were now a series of tacks / staples protruding along the join in the carpet that now required attention. Door handle on the en-suite toilet in the same room was broken. Floorboards next to this bedroom were loose. The registered proprietor gave assurances that this has now been addressed. The Granleys DS0000016610.V288851.R01.S.doc Version 5.1 Page 18 A window pane in one bedroom was broken and must be replaced. The Granleys DS0000016610.V288851.R01.S.doc Version 5.1 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33 & 34 Improved staffing levels should improve opportunities for service users. Recruitment procedures are not sufficiently robust and may compromise service users safety. EVIDENCE: Examination of the rotas showed that the home was providing the additional cover that was required in the mornings and at weekends. The rota provides 4 staff until 9am and 4 staff on an evening shift. However due to staff shortages the manager was making up the required numbers on a regular basis. The deputy manager has recently left the home and two staff have been jointly promoted to cover this role, with the job title of senior carers. The home has filled its current vacancies but two staff were found to have commenced their employment without CRB checks being completed, and an immediate requirement was issued in respect of this. The home were required to risk assess the situation and put measures in place to ensure that the staff did not work unsupervised with the service users. The new staff were yet to be provided with individual files and all the information was contained in one loose folder. All staff should have individual files, which contain all the required information, including references and information about Pova and CRB checks. The Granleys DS0000016610.V288851.R01.S.doc Version 5.1 Page 20 Over the previous several weeks the manager has worked regular care shifts to cover staffing shortages and this partly explains the disorganised paperwork around staff recruitment. Further reference is made to this under the management standards. (Standards 37-43). The home has had regular staff meetings and the minutes from these show that a range of issues are discussed and that staff are provided with information from the manager. Records show that staff are undertaking NVQ training and also receiving supervision from the manager. The Granleys DS0000016610.V288851.R01.S.doc Version 5.1 Page 21 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 41 & 42 The effectiveness of the management is compromised by the continued lack of sufficient designated management hours. The lack of management hours continues to have a detrimental effect on the quality of the service delivered. EVIDENCE: A requirement was made following the last inspection that the home has designated management hours and that the Registered Manager should not routinely undertake care shifts in place of their management responsibilities. The rotas showed that for several weeks the manager has been covering gaps on the rota due to staff sickness or vacancies. As stated in the previous report the inspectors do not believe that the home can function effectively and meet the required standards without a full time manager. The situation has been further compounded by the replacement of the deputy manager, who has recently left, by giving additional responsibilities to two of the more senior staff. When also considering the lack of administration support within the The Granleys DS0000016610.V288851.R01.S.doc Version 5.1 Page 22 home, the inspectors are concerned that the personnel and hours are not in place to ensure that the home is effectively and professionally managed. The shortfalls identified in this report around staff recruitment, care planning, medication and assessments appear to be a direct result of the lack of designated management hours. These issues need to be addressed urgently by the Provider to avoid enforcement action being taken by the Commission. It is felt that the quality assurance systems in the home could be improved significantly to ensure there is better scrutiny of the service provided. There are significant shortfalls in records which are maintained of service users belongings. For some service users these have not been competed at all and where these records are in place these are poor in quality and detail. Records of valuables must be kept. A requirement was made following the previous inspection regarding the effectiveness of the maintenance systems in place. During this visit the inspectors identified a nail that was protruding in a service user’s bedroom carpet. This was brought to the attention of the home but at the subsequent return visit to the home two weeks later the inspectors found that whilst the nail had been removed there were now additional tacks protruding through the floor and the join in the carpet now needed repairing. As during previous visits the inspector found a number of bedroom doors that required the fire safety closures adjusting. Due to the age of the building and the weight of the doors this is apparently an ongoing issue. The log for recording maintenance requests had few entries and the inspectors remain concerned that the systems for identifying and carrying out repairs remains unsatisfactory. The requirement relating to maintenance has been made again and will be examined at the next inspection. The Granleys DS0000016610.V288851.R01.S.doc Version 5.1 Page 23 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 2 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 X ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 X 33 3 34 2 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 X X 2 X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 2 16 X 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 X 2 X 2 X X X 2 2 X The Granleys DS0000016610.V288851.R01.S.doc Version 5.1 Page 24 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA2 Regulation 14(d) Requirement The home must ensure that assessments completed on new admissions contain all the required information on the needs to be met. The home must provide additional management hours(previous timescale not met 31/10/05) The home must continue to improve the care planning sytem in line with comments made in this and the previous report.(previous timescale not met 31/10/05) The home must ensure that new staff do not work unsupervised until all checks have been completed as well as the the induction process(immediate requirement issued) The home must ensure that there is a satisfactory system in place for monitoring maintenance and arranging repairs (previous timescale not met 31/10/05) The home must complete detailed care plans for the new service users in line with their DS0000016610.V288851.R01.S.doc Timescale for action 30/04/06 2 YA37 18(1)(a) 30/04/06 3 YA5 15(c) 30/04/06 4 YA23 19(1)(a) 30/04/06 5 YA42 23 30/04/06 6 YA6 12&14 30/04/06 The Granleys Version 5.1 Page 25 7 YA9 13(4)(c) 8 9 YA20 YA24 13(2) 23 10 YA41 17 assessed needs as identified by the placing authority. The home must develop missing persons information for all service users. This needs to be easily accessible and suitably detailed. Photographs must be obtained for all service users. The home must ensure that medication administered is correctly recorded. The home must repair the broken window in the bedroom at the front of the house. The home must also remove the hazards from the staples which are protruding along the carpet joint in one room and repair the door handle to the en-suite toilet in the same room. The home must complete accurate records of valuables and furniture that belong to service users 30/04/06 30/03/06 30/04/06 30/05/06 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 YA15 YA19 Good Practice Recommendations The home should make arrangements for service users to visit and see their friends. The home should monitor and record peoples weight more regularly The Granleys DS0000016610.V288851.R01.S.doc Version 5.1 Page 26 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Granleys DS0000016610.V288851.R01.S.doc Version 5.1 Page 27 - 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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