Inspection on 22/08/07 for The Granleys

This inspection was carried out on 22nd August 2007.

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 20 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 25/08/06

The Granleys 02/02/06

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 Paul Chapman Key Unannounced Inspection 22nd August 2007 09:00 The Granleys DS0000016610.V349146.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 The Granleys DS0000016610.V349146.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. The Granleys DS0000016610.V349146.R01.S.doc Version 5.2 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 To be appointed Care Home 17 Category(ies) of Learning disability (17) registration, with number of places The Granleys DS0000016610.V349146.R01.S.doc Version 5.2 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. 25th August 2006 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 disabilities. 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 en suite facilities. A copy of the Statement of Purpose and Service User Guide as well as the last inspection report are kept in the main office and are available upon request. The Granleys DS0000016610.V349146.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 a visit to the service and takes into account the views and experiences of people using the service. This inspection was completed over 3 site visits to the home, on 22/08/07, 01/09/07 and 22/10/07. On the first day of the site visits the manager was not on duty and the senior support worker spent the day with the inspector. There were some areas that they were unable to answer and so another day was arranged with the manager. On the 22/10/07 the CSCI visited the home to examine staffing records. On the 1st day of the inspection a tour of the premises was completed. In addition to this Person Centred Plans (PCPs) for 9 people were examined and the care of four people was looked at in depth. This included looking at their financial, medication and personal records. Four staff were interviewed about the care they provide. Other records examined included staff files, and health and safety information. Completed surveys were received from eight people living at the home and one doctor. Time was spent observing the care of people and their interactions with staff. All people living at the home were spoken to and several people’s rooms were inspected on their invitation. The acting manager completed an AQAA (Annual Quality Assurance Assessment) as part of the inspection, providing considerable information about the service and plans for further improvement. What the service does well: What has improved since the last inspection? People are now being offered more activities in and outside the home. People are being given more responsibilities in their day-to-day lives. The Granleys DS0000016610.V349146.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Granleys DS0000016610.V349146.R01.S.doc Version 5.2 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.V349146.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Prospective new admissions and people living in the home do not have access to up-to-date information in the form of the Service User’s Guide. This makes it difficult for people to clearly understand what their rights are, and what service they can expect. The Statement of Purpose should have been reviewed as part of the previous inspection requirements. Failure to meet this requirement further limits the amount of the information available to people living in the home. Prospective new admissions to the home are thoroughly assessed before being offered a place. EVIDENCE: The previous inspection report made 2 requirements against standard 1. • The registered person must ensure that the Statement of Purpose and Service User’s Guide are reviewed and that copies are forwarded to the CSCI. Service users must also have access to these documents. • The registered person must ensure that the Statement of Purpose includes reference to the homes’ policy and procedure for emergency admissions and that respite care is not provided. The Granleys DS0000016610.V349146.R01.S.doc Version 5.2 Page 9 Since the previous inspection was completed the registered manager has left. The CSCI have not received copies of these documents. The acting manager found a copy of the Statement of Purpose, but not the Service User’s Guide. The Statement of Purpose had no date on it and it and it was impossible to confirm that it had been reviewed. Therefore the requirement of the previous inspection is carried over in this report. There has been one admission to the home since the previous inspection was completed. Examination of the process completed before the person moved in showed that it was comprehensive. In the AQAA completed by the acting manager she states that she feels there is probably room for improvement in the assessment process and she will monitor this while completing them in the future. One idea the manager has identified is the use of pictorial prompts to make the assessment more user friendly. This would be a good practice once implemented. The Granleys DS0000016610.V349146.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home do not have person centred plans and it is impossible to confirm that the recorded needs of people living in the home are accurate due to them not being reviewed. Staff have a limited knowledge of the care plans and this may lead to people receiving care that does not meet their needs. There is no record of people being involved in making decisions about their lives due to the records available to inspect. People are becoming more involved in the day-to-day running of the home but records do not accurately reflect this. People are being put at unnecessary risk due to the home’s poor risk assessments. EVIDENCE: The previous inspection report made a requirement against standard 6. The registered person must ensure that all care plans are in place, and are being regularly monitored and reviewed. The Granleys DS0000016610.V349146.R01.S.doc Version 5.2 Page 11 Care files for 9 of the people living in the home were examined in detail. Person Centred Plans (PCP) were present for each person. None of the PCP’s seen had been reviewed for a number of months. In most cases 12 months. Any goals identified in the PCP’s were not specific, measured, achievable, realistic or time-constrained. It was difficult to identify when the majority of the PCPs were written, as they were not dated. Recording seen in the PCPs was poor, with the language used being poor and no regular updates being completed. Speaking with staff they stated that they did not have any involvement in creating the PCP’s as the previous manager had written them all. When speaking to people living in the home they were asked about their PCP’s and their involvement in developing them. None of the people spoken with were aware that they had a PCP, or what it was. There was no evidence of any involvement by the people living in the home in the development of their PCPs. The format of the PCP document has the potential to form the basis of a good document. Unfortunately in its current form it is ineffective. The acting manager is aware that all of the PCPs must be reviewed. It becomes a requirement of this inspection report that the PCPs for all of the people living in the home are reviewed and re-written with their involvement. The home uses a standex system for recording notes for people. Although these provided detail of activities and appointments attended they provided little evidence of people being supported to make decisions about their lives. Where staff support people to make decisions about their lives it must be recorded. This becomes a requirement of this inspection report. Staff explained that people living in the home have started being more involved in the day-to-day running of the home. The manager must ensure that this continues to develop with people being able to have more and more input. Evidence of this must be available. This becomes a requirement of this inspection report. The care files examined contained a number of risk assessments. The assessments seen were poor. They were not dated, there was no evidence of regular reviews and the majority of cases did not provide staff with guidelines to minimise potential risks. Examples of shortfall identified as part of the site visit include there being no risk assessment for a person accessing the community unsupported, they had no road safety risk assessment and no missing persons risk assessment/procedure. It becomes a requirement of this inspection report that all of the people living in the home have comprehensive risk assessments that cover all areas of their lives. In addition to this missing persons procedures must be created for each of the people living in the home. The Granleys DS0000016610.V349146.R01.S.doc Version 5.2 Page 12 The completed AQAA highlights that the “people are given their plans and they are pinned to the inside of their bedroom door”. In their current format the PCPs are not person centred, may not meet current needs, as they have not been reviewed regularly. In some cases people will not be able to understand them due to communication difficulties. The AQAA highlights the manager’s plan to review all of the PCPs. The Granleys DS0000016610.V349146.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 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The range of activities have been recognised as being poor by the acting manager and they have taken steps to address this by employing an activities co-ordinator. People stated that the food was nice but choice could be increased through reviewing the current system. EVIDENCE: Before the first day of this site visit was completed the acting manager recognised the need to employ a staff member specifically to co-ordinate activities during the day. Staff were asked what activities took place. 1 member of staff commented “not an awful lot” and explained that the same people did the same things – The Granleys DS0000016610.V349146.R01.S.doc Version 5.2 Page 14 puzzles, lego and colouring. The staff member stated that hopefully this would be addressed with the employment of additional staff. During one of the site visits people were observed completing puzzles, colouring and using Lego. Observations of the interactions between the staff and people living in the home were positive. People were seen to be treated with respect and dignity. At the time of the first site visit a number of people were out at day services. Other people living at the home have jobs or other activities they complete during the day. People regularly visit the everyman and spa clubs during the evening. People are able to attend a local church if they wish. At the second site visit the acting manager was present and explained their vision for the future activities. At this point the activity co-ordinator had started in post and the manager stated that they had been speaking to people living in the home individually to identify activities they may wish to do. Some of the planned activities include creating a vegetable/flower patch in the garden where people will be able to grow what they choose, bingo, cooking and pottery. More activities outside the home are being planned. It becomes a requirement of this inspection report that the people living in the home have more access to age, peer and culturally appropriate activities. Due to the detail in the notes it was difficult to evidence that peoples rights were being respected. The acting manager has started to promote people having responsibilities in their lives. Examples of this could be people being asked to help cook meals, cakes, shopping for groceries and completing tasks including cleaning around the home. Again this needs to be developed and evidenced by the acting manager and her team. This becomes a requirement of this inspection report. Speaking with people living in the home they stated that they have contact with members of their family. Some people visit their family at home whilst others come to the home to visit their relatives. Relationships with family and friends is encouraged. Resident meetings are being held monthly. The manager explained that people living in the home are now involved in completing the shopping for groceries. Staff confirmed this. Menus run on a 3-week rolling rota. There is a summer and winter menu and the winter menu was recently reviewed at a resident meeting. People spoken with stated that the food was nice and there was enough to eat. A recommendation of this report would be to review the practice of having a rolling rota and look at other methods which would enable people to have more The Granleys DS0000016610.V349146.R01.S.doc Version 5.2 Page 15 choice. An example of this may be asking people weekly what they would like for the following week. The AQAA completed by the manager highlights the need to increase people’s inclusion in activities and write programmes for completing household tasks. The manager highlights the need to be “proactive regarding the choice for individuals”. The Granleys DS0000016610.V349146.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, 21 People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Care plans to identify peoples personal care needs do not provide sufficient detail to allow staff to meet peoples needs consistently. Recording of people’s medical appointments is poor and confusing which may lead to staff missing important information. Medication administration is putting people at unnecessary risk. EVIDENCE: A number of people living in the home require staff support to maintain their personal care and hygiene. Examination of these care plans showed that they did not provide staff with sufficient detail to meet peoples needs consistently. They had also not been reviewed regularly since the previous inspection was completed. It becomes a requirement of this inspection report that where people require support with their personal care that detailed care plans are in place that enable staff to consistently meet peoples needs. The care plans must then be reviewed regularly. The Granleys DS0000016610.V349146.R01.S.doc Version 5.2 Page 17 All of the files we examined contained completed health action plans and hospital assessments. All of the sampled files provided records that people had attended their doctor/practice nurse for an annual health check. A shortfall in the recording was that some staff were recording appointments in the standex filing system, while others were recorded in peoples action plans. The manager must decide where this information will be recorded as the current recording is confusing. This becomes a recommendation of this inspection report. The home’s medication administration was examined. The home has a medication policy that was reviewed in June 2007. A senior carer has responsibility for overseeing the medication. Records were available to show that medication was examined on entering the home to ensure that the correct quantities and dosages were received. Records of disposal were also available but a recommendation would be to ask the pharmacist receiving the returns to sign confirming that they have. Examination of the medication administration sheets showed there were a number of gaps where staff had not initialled to confirm the person had taken their medication. The manager must monitor this, as it is impossible to confirm that people have taken their medication when they were supposed too. This becomes a requirement of this inspection report. Examination of the medication stored in the home showed a couple of shortfalls. There were a selection of topical creams and cough mixtures that were open but were not labelled with the date they were opened. The manager must ensure that this is done in the future and this becomes a requirement of this inspection report. A requirement of the previous inspection report was that all staff should receive training in medication administration before they undertake these duties. The manager has introduced a system where new staff will observe a trained staff member administer medication 5 times, and then a trained member of staff will observe the new staff member administer medication 10 times. In addition to this in-house training all staff will complete external medication training as well. None of the files sampled by us contained information relating to peoples wishes if they become seriously ill. The manager must ensure that this is addressed. This becomes a requirement of this inspection report. The Granleys DS0000016610.V349146.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 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home has a complaints procedure and people spoken with stated that if they were unhappy they would speak to staff. Peoples finances are being put at unnecessary risk due to the amount being kept in the home. All staff must complete safeguarding adults training to minimise potential risks to people. EVIDENCE: The home has a complaints procedure. Speaking with some of the people living in the home they were aware of the procedure. Each person has a copy of the procedure in their bedroom and this is available in written and picture formats. A requirement of the previous inspection report was that the procedure must make reference to the CSCI. Examination of the procedure showed that this had been done. In the AQAA completed by the manager they state that they will remind people of the complaints procedure in the monthly resident meetings. No complaints have been made to the home, or the CSCI since the previous inspection was completed. Speaking with staff individually they were asked about other indications that may show people are unhappy if they were unable to communicate verbally. All of the staff gave detailed answers showing they had a good knowledge of what to be aware of and the steps to take if they were concerned. The Granleys DS0000016610.V349146.R01.S.doc Version 5.2 Page 19 Examination of people’s finances showed that at the time of the site visit substantial amounts of peoples money was being kept in the home. The manager explained that this was to fund activities. A discussion took place with the manager about keeping smaller amounts in the home with the rest being put into people’s savings accounts. We advised the manager to examine the home’s insurance policy, as it was likely that they would only be covered up to a certain amount. This becomes a recommendation of this inspection report. Training records showed that a number of the staff had completed training in safeguarding adults. It is a requirement of this inspection report that all staff that work in the home complete this training. The manager identifies this as a goal in the AQAA they completed The Granleys DS0000016610.V349146.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, 25, 26, 27, 28, 30 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provides people with sufficient communal space to meet their current needs. The environment is homely and comfortably furnished. The home is clean and tidy due to the home employing a dedicated cleaner. EVIDENCE: A tour of the premises was completed with the member of senior care staff on duty at the 1st site visit. All of the communal areas were seen and with the permission of people living in the home a sample of the bedrooms. The entrance hall to the home is nicely decorated and contained a sofa, chairs and a piano. On the wall was a copy of the home’s fire escape procedure. The home provides people with a large lounge/diner with 3 tables, a range of chairs and sofas, a television, DVD player and a stereo. It was noted that there The Granleys DS0000016610.V349146.R01.S.doc Version 5.2 Page 21 was some water damage on the ceiling. There are 2 fire doors leading from the lounge. One was missing the luminescent strip, whilst the other was slightly warped and did not close properly. The bedrooms seen were pleasantly decorated and personalised with people’s possessions. One person stated that they had chosen the colour of their bedroom. Of the bedrooms seen a number have door locks, where doors do not have locks the manager must ask people whether they would like them. This becomes a requirement of this inspection report. There were a number of maintenance issues around the home. The senior carer on duty at the 1st site visit explained that with the manager they had completed a tour of people’s bedrooms highlighting various maintenance issues. A list had been made and given to the provider. The shortfalls identified by this site visit include: 1. The water damage to the ceiling of the lounge/diner. 2. The fire doors to the lounge must be repaired to ensure that people are not being put at risk. 3. 1 of the bedrooms seen did not have a lampshade and this must be replaced. 4. In 1 bedroom the curtains were to short for the window and must be replaced. 5. In the main bathroom tiles were coming away from the wall and this must be rectified. A number of requirements relating to the environment were made in the previous inspection report. The tour of the premises showed that these requirements have been addressed. In the AQAA completed by the manager they state they that the décor could be improved and that they will be speaking to the proprietor about this. The tour of the premises confirmed this with a lot of the building looking quite “tired”. The home was clean and tidy on the 3 occasions when these site visits were completed. The home employs a cleaner. The home’s laundry is to the rear of the property in an outhouse. There were colour coded mops and buckets for different areas of the home. Hazardous products are stored securely and COSHH data sheets are in place. The manager agrees that there are a number of maintenance issues that must be addressed. They stated that they have made the proprietor aware a number of these issues and they are being addressed. On the 3 occasions when we visited a number of maintenance staff were in the home addressing various issues. The manager must supply the CSCI with a maintenance programme for the next 12 months. This becomes a requirement of this inspection report. The Granleys DS0000016610.V349146.R01.S.doc Version 5.2 Page 22 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 People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Some of the previous recruitment procedures have not met the criteria of these regulations and may have put people living in the home at unnecessary risks. Staff training has improved in recent months but specific training needs remain outstanding, which is putting people at unnecessary risk. EVIDENCE: At the 3rd site visit we returned to speak to the manager about staff recruitment and examine the records. We examined records for 10 of the staff team including the manager. Some shortfalls were identified. This was in part due to the application form used by the home which asks potential staff for their employment history for the previous 10 years, and does not asks for the start and finish dates of jobs. We discussed this with the manager and it is recommended that the application form is reviewed. All potential staff should provide a full employment history with the start and finish dates for each position. Where The Granleys DS0000016610.V349146.R01.S.doc Version 5.2 Page 23 there is a gap in a person’s employment history this must be investigated by the manager. The staff files examined were well organised and the manager stated that they had re-organised them when they started in post. Some shortfalls in the information provided in the files were discussed with the manager. The manager should complete a review of the staff files to ensure that all of the information required by these regulations is present. This becomes a requirement of this inspection report. Each of the staff files seen contained their records of training they have completed. The manager stated that they have arranged for the staff team to receive Makaton training (total communication using signs and symbols), and the Stoma nurse is visiting to provide the staff with training on stoma care. This is good practice as previously the training in stoma care has been completed in house. Speaking to staff they stated that they had completed training in topics including fire safety, safe handling of medication, food hygiene, first aid, manual handling and infection control. Records seen in staff files support this. A requirement of the previous inspection report was for the staff team to receive training in learning disabilities, older person care and dementia. This requirement has not been met. The same issues still remain in the home and this requirement is carried over in this inspection report. Staff meetings are now being held monthly and staff are receiving supervision monthly by the manager or the senior support worker. The AQAA completed by the manager states that 4 staff have completed their NVQ (National Vocational Qualification) in care at level 2 or above, while the other 12 staff are in the process of completing theirs. The Granleys DS0000016610.V349146.R01.S.doc Version 5.2 Page 24 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, 40, 42 People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The acting manager was aware of a number of the shortfalls highlighted by this report and showed a commitment to ensure they are addressed. People living in the home are becoming more involved in planning the service but a quality assurance system that involves them will help to promote this. Health and safety checks must be more comprehensive to minimise potential risks to people living in the home. EVIDENCE: Since the previous inspection was completed the registered manager has left the home. The acting manager has been in post since April 2007 and has 10 years managerial experience in similar settings. The acting manager has The Granleys DS0000016610.V349146.R01.S.doc Version 5.2 Page 25 applied for registration with the CSCI. Speaking with the manager about the home they showed a good awareness of the shortfalls highlighted in this report and have already addressed a number of them. As a result of the findings of this inspection the manager will have to provide the CSCI with an improvement plan detailing a timescale for when each of these shortfalls will be addressed. The home’s certificate of registration was displayed, and the employer’s insurance certificate was displayed in the entrance hall. It was noted that this certificate was out of date. The proprietor must ensure that the new certificate is displayed. At the time of this site visit there was no system in place for evaluating the quality of the service provided at the home, taking in the views of people living in the home. This was a requirement of the previous inspection report that has not been met. We discussed possible methods the manager could use to achieve this, including the use of questionnaires with family members and other professionals and resident meetings. There was no evidence of regulation 26 visits being completed by the proprietor of the home. It becomes a requirement of this inspection report that these visits are completed as defined by the regulations. The AQAA completed by the manager states that they would complete a review of all of the home’s policies and procedures. The majority of the policies and procedures were reviewed in July 2006. Health and safety was examined: • • • • • Hot water outlet temperatures are not being monitored monthly. This must be addressed with the temperatures being recorded monthly. Fridge and freezer temperatures are not being recorded daily, and this must be addressed. Fridge/freezer temperatures must be taken and recorded twice daily. A food probe is not being used regularly to record the temperature of food produced. This must be addressed. Stairs lifts had not been serviced by a qualified engineer in the past 12 months. This must be addressed. The equipment in the assisted bathroom was serviced in July 2007. The areas highlighted in the above list must be addressed by the registered person and become requirements of this inspection report. However, we found a fire risk assessment had been completed and fire safety equipment is checked regularly by the staff. A qualified engineer has completed a maintenance check of the alarm system. Portable appliance testing was completed in July 2007. The Granleys DS0000016610.V349146.R01.S.doc Version 5.2 Page 26 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 1 2 3 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 3 23 2 ENVIRONMENT Standard No Score 24 2 25 2 26 3 27 2 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 1 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 2 2 1 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 2 2 X 1 2 X 1 X The Granleys DS0000016610.V349146.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA1 Regulation 6 Requirement The Statement of Purpose and Service User Guide must be reviewed and copies forwarded to the Commission. People living in the home must have access to the new documents. (This requirement has been repeated from the last inspection-timescale for action 30/11/06). The Statement of Purpose must include a reference to the homes’ policy and procedure for emergency admissions and that respite care is not provided. (This requirement has been repeated from the last inspection-timescale for action 31/11/06). The Person Centred Plans must be reviewed and re-written with the involvement of the people they are for. All PCP’s and care plans must then be reviewed regularly. Risk assessments must be in place for all of the people living DS0000016610.V349146.R01.S.doc Timescale for action 04/01/08 2. YA1 4(1)(c) Sch 1.8 04/01/08 3. YA6 15(c) 01/03/08 4. YA9 13(4)(c) 04/01/08 The Granleys Version 5.2 Page 28 in the home. These risk assessments must cover all areas of their lives and provide strategies to minimise potential risks. 5. YA12 12(4) The continuing to development of a range of needs led activities that are age appropriate will ensure that the dignity of the people living in the home is respected. There must be continued development of activities that ensure people maintain their roles in the local community. There must be continued development of activities that enhance peoples’ rights and responsibilities. Care plans relating to peoples personal care needs must be review and re-written to provide greater detail. This will enable staff to meet people’s needs consistently and allow for reviews of peoples changing needs in this area. Medication administration must be regularly monitored to ensure that if there are discrepancies that they are address promptly. Each person living at the home must be given the opportunity to record their wishes in the case that they become seriously ill. All staff must complete safeguarding adults training. The shortfalls highlighted in the body of the report must be addressed. DS0000016610.V349146.R01.S.doc 01/02/08 6. YA13 16(2) m, n 01/02/08 7. YA16 16(2) m, n 01/02/08 8. YA18 12(3), (4) a, 15 01/02/08 9. YA20 13 (2) 07/12/07 10. YA21 15 01/03/08 11. 12. YA23 YA24 13(6) 23 01/03/08 04/01/08 The Granleys Version 5.2 Page 29 The CSCI must be supplied with a maintenance program with timescales for the updating of the decoration around the home. 13. YA25 23 The issues highlighted in the body of the report relating to people’s bedrooms must be addressed. The tiles that are coming away from the wall in the main bathroom must be repaired. Staff files must be reviewed to ensure that all of the information required by these regulations is present. The registered person must ensure that staff receive training appropriate to the needs of the people they support such as learning disability and the older person and dementia. (This requirement has been repeated from the last inspection-timescale for action 31/03/07). The registered person must establish a system for evaluating the quality of services provided at the home, taking the views of service users into account and producing a summary report. (This requirement has been repeated from the last inspection-timescale for action 31/03/07). Regulation 26 visits must be completed by the proprietor of the home. The following areas must be addressed to minimise potential risks. • Hot water outlets must tested monthly to ensure DS0000016610.V349146.R01.S.doc 07/12/07 14. 15. YA27 YA34 23 19(1) Sch. 2. 04/01/08 04/01/08 16. YA35 18(1)(c) 01/03/08 17. YA39 24 01/03/08 18 19. YA39 YA42 26 13(4) a, c 07/12/07 07/12/07 The Granleys Version 5.2 Page 30 20. YA42 13(4) a, c that they remain within the safe working parameters. • Fridge and freezer temperatures must be recorded twice daily. • A food probe must be used to test cooked food products. An appropriately qualified 07/12/07 engineer must service the stair lifts in the home. 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 YA19 Good Practice Recommendations Records of appointments with doctors or other medical professionals should be recorded in one place to stop confusion in the future. Substantial amounts of money should not be kept in the home’s safe and should be deposited in their individual bank accounts. The home’s staff application form should be reviewed to ask potential staff for a full employment history, and for the dates they started and finished previous positions. Policies and procedures should be reviewed to ensure that they accurately reflect the current practices around the home. 2. 3. 4. YA23 YA34 YA40 The Granleys DS0000016610.V349146.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB 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. 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