Inspection on 25/08/06 for The Granleys

This inspection was carried out on 25th August 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 no outstanding requirements from the previous inspection report, but made 12 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 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 MIXED CATEGORY MAJORITY ADULTS 18-65 The Granleys 21 Griffiths Avenue St Mark`s Cheltenham Glos GL51 6SJ Lead Inspector Ms Lynne Bennett Key Unannounced Inspection 08:00 25th August 2006 The Granleys DS0000016610.V296781.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.V296781.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 and 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.V296781.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 Miss Amy Clare Ranger Care Home 17 Category(ies) of Learning disability (17) registration, with number of places The Granleys DS0000016610.V296781.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. 2nd February 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. The fees for the home range from £313 to £723 per week. Each person living at the home has a copy of the Service User Guide. 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.V296781.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 took place in August 2006 and included a visit to the home on 25th August. The registered manager was in attendance for most of the visit. All people living at the home were met and time was spent observing the care of 8 people during the day. Four people living at the home expressed their feelings about the care they receive. A comment card was received from one relative and a healthcare professional. Four staff discussed the care they provide to people living at the home and others were observed during the visit. A pre-inspection questionnaire was returned prior to the visit and a selection of service users’ files, staff files and health and safety records were examined. At the request of the lead inspector a CSCI pharmacist inspector checked arrangements for handling of medicines (Standard 20 of The National Minimum Standards – Care Homes for Adults 18 - 65) at a 4-hour inspection on 5 September 2006. This forms part of the key inspection. Medicine stocks and storage arrangements, medicine administration charts and other records and procedures relating to medication were looked at. One member of staff was spoken to and the manager (who was off duty) called in for some of the period. What the service does well: What has improved since the last inspection? The new format of care plan has been put in place for all people living at the home. The Granleys DS0000016610.V296781.R01.S.doc Version 5.2 Page 6 A missing person’s record has been put in place for all people including their description and a photograph. A maintenance firm has been retained to deal with day-to-day repairs at the home. A record of valuables and furniture belonging to people living at the home has been put in place. 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.V296781.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Individual Needs and Choices Lifestyle Personal and Healthcare Support Concerns, Complaints and Protection Environment Staffing Conduct of Management of the Home Scoring of Outcomes Statutory Requirements Identified During the Inspection Adults 18 – 65 (Standards 1–5) (Standards 6-10) (Standards 11–17) (Standards 18-21) (Standards 22–23) (Standards 24–30) (Standards 31–36) (Standards 37-43) Older People (Standards 1–5) (Standards 7, 14, 33 & 37) (Standards 10, 12, 13 & 15) (Standards 8-11) (Standards 16-18 & 35) (Standards 19-26) (Standards 27-30 & 36) (Standards 31-34, 37 & 38) The Granleys DS0000016610.V296781.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 (Adults 18 – 65) and Standards 1 – 5 (Older People) are: 1. 2. 3. Prospective service users have the information they need to make an informed choice about where to live. (OP NMS 1) Prospective users’ individual aspirations and needs are assessed. No service user moves into the home without having been assured that these will be met. (OP NMS 3) Prospective service users’ know that the home that they choose will meet their needs and aspirations. Service Users and their representatives know that the home they enter will meet their needs. (OP NMS 4) Prospective service users’ have an opportunity to visit and “test drive” the home. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. (OP NMS 5) Each service user has an individual written contract or statement of terms and conditions with the home. Each service user has a written contract/statement of terms and conditions with the home. (OP NMS 2) 4. 5. The Commission considers Standard 2 (Adults 18-65) and Standards 3 and 6 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 (Adults 18-65) and 1,3 and 6 (Older People) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A review of the Statement of Purpose and Service User Guide will ensure that people wishing to live at the home have access to the latest information. An assessment of the needs and wishes of people who would like to live at the home is completed to assess whether the home is able to meet their needs. EVIDENCE: The Statement of Purpose and Service User Guide were last reviewed in 2003. These documents must be reviewed in line with changes that have taken place in the service such as the increasing number of people living at the home over the age of 65 and changes to the management structure of the home. People living at the home must have access to these new documents and copies must The Granleys DS0000016610.V296781.R01.S.doc Version 5.2 Page 9 be forwarded to the Commission. The manager must also ensure that reference to the Commission is included in the complaints procedure. (See also Standard 22) The manager stated that people living at the home contribute 50 of their mobility allowance towards transport costs. This must also be included in the Statement of Purpose. Two people were admitted to the home towards the end of 2005. One person was admitted as an emergency admission. Information was obtained from the placing authority at the time of admission including an assessment and care plans. This person has since decided to stay at the home. There was evidence of an initial review and a three-month review to confirm that they are staying at the home. The manager must ensure that the revised Statement of Purpose makes reference to the home’s procedures for emergency admissions and that the home does not provide respite care. Full assessment and admission information was collated for the other person who moved into the home including the home’s own assessment. The registered manager confirmed visits were arranged to the home. The Granleys DS0000016610.V296781.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6-10 (Adults 18-65) and Standards 7, 14, 33 & 37 (Older People) are: 6. Service users know their assessed and changing needs and personal goals are reflected in their Individual Plan. The Service Users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users make decisions about their lives with assistance as needed. Service Users are helped to exercise choice and control over their lives. (OP NMS 14) Service users are consulted on, and participate in, all aspects of life at the home. The home is run in the best interests of service users. (OP NMS 33) Service users are supported to take risks as part of an independent lifestyle. The service users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users know that the information about them is handled appropriately and that their confidences are kept. Service Users rights and best interests are safeguarded by the home’s record keeping, policies and procedures. (OP NMS 37) 7. 8. 9. 10. The Commission considers Standards 6, 7 and 9 (Adults 18-65) and Standards 7, 14, and 33 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 (Adults 18-65) and 7,14 and 33 (Older People) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The care planning system although adequate does not reflect the personal goals and wishes of people living at the home. The present system does not promote the development of skills and independence. Financial procedures although greatly improved need to be reviewed to ensure that personal monies are safeguarded from possible misuse. Risk assessments need to encourage and support people living at the home to challenge and deal with problem areas in their lives. EVIDENCE: The Granleys DS0000016610.V296781.R01.S.doc Version 5.2 Page 11 A person centred pro-forma (PCP) has been introduced for all people living at the home and these are in varying stages of completion. The plan for one person who moved into the home in December 2005 has no entries after January 2006 and was only partially completed. Other plans examined had been reviewed in August 2006. The registered manager said that she would be completing individual assessments for all people living at the home that would form the basis of future review of care plans. It is still not evident how people living at the home are being involved in developing their plans and identifying their wishes and aspirations. The registered manager said that she attended training in the person centred approach with senior staff and was intending to cascade this training to the staff team. Plans appeared to reflect needs identified in community care assessments and plans from placing authorities such as encouraging a person to go to the optician and helping in the kitchen. A person was observed wearing new glasses and also helping to clear away dishes in the kitchen. However the same assessment indicated that the person should be encouraged to make drinks and prepare meals. This was not reflected in their PCP or observed during the day. After discussion with a senior team member it was noted later in the visit that the person was being encouraged to make their own drink. In addition to the PCP’s people have a standex care plan that is used to provide a pen picture of their needs that are monitored and reviewed on a daily basis. Some key workers write monthly reports providing a summary of the needs of people living at the home. There was no evidence of this for the person who moved into the home in December 2005. There was evidence for one person over 65 that a specialist assessment for complex and nursing needs had been completed, in addition to a dementia care pathway. The home is working closely with the local Community Learning Disability Team to provide continuing support to this person as their needs change as they become older. Suggestions from a Speech and Language Therapist about the support they require when eating and drinking have been incorporated into their PCP. People living at the home are involved in the choice of menu and have had two residents meetings in the past six months. At these they have discussed choice of menus and activities as well as helping out in the kitchen. Information about a local advocacy group was displayed in the hall and a member of staff said that a local advocate had visited the home to meet with people living there. People are supported to manage their finances. Consent for this should be included in their PCP’s. Staff were observed checking the daily balances, recording expenditure and logging receipts. It was noted that when people go out for a meal they are paying for this themselves as well as paying a contribution towards staff meals. If the meal out is replacing a meal that The Granleys DS0000016610.V296781.R01.S.doc Version 5.2 Page 12 would normally be provided by the home then this should be paid for by the home. Staff meals should also be paid out of the home’s petty cash system and not funded by people living at the home. The registered manager may wish to review the policy and procedure for the management of service users’ money and personal affairs. Risk assessments are in place minimizing hazards identified in care plans. These are being regularly reviewed. People living at the home have limited access to the kitchen for the making of drinks and helping to cook the evening meal. Reasons for this need to be identified in their PCP’s and risk assessments. Several staff indicated that people did not make their own drinks because they are at risk of scalding. This has created an environment where people living at the home expect to be waited on for their drinks and meals rather than being supported by staff to help in the process of making a drink or a meal. As mentioned a senior team member was observed supporting a person to make a drink by asking them to choose a cup into which they could put a teabag. This is a positive start to enabling people to gain skills in activities of daily living. (People have the opportunity to bake cakes with staff as part of the scheduled in house activities). Some people have keys to their rooms but not all people living at the home have access to a key. The reason for this must be recorded in their PCP. Since the last inspection a missing person’s folder has been put together. Each person has a proforma with personal information and a photograph. The Granleys DS0000016610.V296781.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 (Adults 18-65) and Standards 10, 12, 13 & 15 (Older People) are: 11. Service users have opportunities for personal development. 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. (OP NMS 12) Service users are able to take part in age, peer and culturally appropriate activities. 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. (OP NMS 12) Service users are part of the local community. Service users maintain contact with family/ friends/ representatives and the local community as they wish. (OP NMS 13) Service users engage in appropriate leisure activities. 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. (OP NMS 12) Service users have appropriate personal, family and sexual relationships and maintain contact with family/friends/representatives and the local community as they wish. (OP NMS 13) Service users’ rights are respected and responsibilities recognised in their daily lives. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users are offered a (wholesome appealing balanced) healthy diet and enjoy their meals and mealtimes. Service users receive a wholesome appeaing balanced diet in pleasing surroundings at times convenient to them. (OP NMS 15) 12. 13. 14. 15. 16. 17. The Commission considers standards 12, 13, 15, 16 and 17 (Adults 1865) and Standards 10, 12, 13 and 15 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17 (Adults 18-65) and 10,12,13 and 15 (Older Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Improvements in the provision of social and leisure activities at home will be further improved by providing age appropriate activities. The Granleys DS0000016610.V296781.R01.S.doc Version 5.2 Page 14 Educational, social and recreational activities are being scheduled enabling people living at the home to access their local community. Contact with family and friends is encouraged and supported. The nutritional needs of people over 65 are being monitored and professional advice is being obtained to ensure that these needs are being met. EVIDENCE: Daily plans are in place for each person and staff confirmed that these are mostly followed although some flexibility is allowed for in house activities such as art and crafts or baking should people decide to go out for the day. Some people living at the home attend local day centres or go to college as well as aqua aerobics and swimming. Daily records give an overview of activities provided including shopping, going for a meal and to social clubs two evenings per week. On the day of the visit people walked around to a local café and had a meal. They appeared to have enjoyed themselves. They also regularly use local buses. On the day of the visit there was an art session. This involved colouring pictures and whilst people were occupied questions are raised about the age appropriateness of this activity. A member of staff employed as a carer has a degree in dance and movement. It is recommended that these skills be used to the benefit of people living at the home. Daily records confirm contact with friends and family. One person was looking forward to going home for the weekend and another said that they liked to keep in touch by telephone. Several people over 65 were observed during the course of the visit being supported by staff to take life at a pace dictated by their needs. Some chose to stay in bed late whereas others were supported to have a leisurely breakfast before joining in activities for the morning. A person living at the home was observed helping to make their bed and take the washing down to the laundry. Staff said that others take responsibility for helping to lay tables and clear away dishes. Some help to load the dishwasher. They also have responsibility for cleaning their rooms. The registered manager described how they are supported by staff to keep their rooms clean which are then also cleaned weekly by the home’s cleaner. A range of freshly produced and frozen meals is provided. A selection of fresh salad ingredients and fruit were available on the day of the visit. Menus appeared not to provide a selection of fresh vegetables although staff indicated that these are provided. The Granleys DS0000016610.V296781.R01.S.doc Version 5.2 Page 15 Monitoring charts are kept for some people monitoring their fluid intake. One person is provided with a soft diet. They have the support of a nutritionist. Staff described how they puree items separately. Staff were observed following the person’s PCP when helping them to eat their lunch. Daily notes maintain a record of what each person has eaten. Weight records are also kept and nutritional risk assessments are in place. The Granleys DS0000016610.V296781.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 – 21 (Adults 18-65) and Standards 8 – 11 (Older People) are: 18. 19. 20. Service users receive personal support in the way they prefer and require. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users’ physical and emotional health needs are met. Service users’ health care needs are fully met. (OP NMS 8) 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. Service users, where appropriate, are responsible for their own medication and are protected by the home’s policies and procedures for dealing with medicines. (OP NMS 9) The ageing, illness and death of a service user are handled with respect and as the individual would wish. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. (OP NMS 11) 21. The Commission considers Standards 18, 19 and 20 (Adults 18-65) and Standards 8, 9 and 10 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 and 21 (Adults 18-65) and 8,9,10 and 11 (Older People) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Quality in the outcome area regarding medication is adequate but with some poor practice. This judgement has been made using available evidence including a visit to this service by a pharmacist inspector. The healthcare needs of people living at the home are well met with evidence of multi disciplinary support on a regular basis. People living at the home have access to a range of healthcare professionals making it possible to meet their physical and emotional health needs. The changing needs of older people living at the home are handled with respect and sensitivity. There are arrangements in place for the management of medicines but these are not always used or followed effectively. Some action and more attention The Granleys DS0000016610.V296781.R01.S.doc Version 5.2 Page 17 to detail are needed to fully comply with this standard. Regular checks are needed to make sure that the medicine arrangements are effective in protecting the health and wellbeing of service users. EVIDENCE: The way in which people wish to be supported with their personal and healthcare needs are identified in their PCP’s. There are clear guidelines in place for a person over 65 whose healthcare needs are changing. There is evidence that staff at the home are working closely with healthcare professionals and the local Community Learning Disability Team. There was evidence that an annual health check had been completed and that “My end of life book” had been completed with relatives and plans made for a funeral. This has been sensitively dealt with and is to be commended. A best interests meeting has been held with regard to future medical intervention for one person. This was done in a multidisciplinary forum. This is good practice. Staff have been trained in a specific care procedure from a District Nurse and have also been trained by an Occupational Therapist in the use of hoists. Good records are maintained of healthcare appointments providing evidence that people living at the home have regular access to doctors, dentists, opticians and chiropodists. The registered manager has obtained copies of Health Action Plans that are being completed with healthcare professionals. There is a medicine policy on file reviewed by the manager July 2006. This may need changes in the light of information from this inspection. There was an old medicine policy dated 1996 on the medicine cupboard. This had out of date information. Medicine administration charts are produced by a local pharmacy that also supply the medicines in a monitored dose system (MDS). Staff handwrite some records where there are changes between the monthly charts but do not sign these. The strengths of some medicines were not fully recorded and it was difficult to know what date the medicines were given as only the day was noted (no month and year). A second member of staff should check and sign the entries as copied correctly. Medicine doses were not signed as given for 8am on the day of inspection. The tablets were missing from the packs and the member of staff in charge said she had given the medicines. There was no explanation for a dose marked ‘other’ on the chart. Some doses were not signed as given on 4/9/06 at 1200, 1600 or 2100 although the tablets were not in the medicine packs. A dose of medicine due at 1600 on 4/9/06 remained in the pack but no The Granleys DS0000016610.V296781.R01.S.doc Version 5.2 Page 18 explanation for the missed dose. There were a few gaps in some previous administration records. Records for a resident with a different tablet dose on alternate days did not show what dose was given on each day. There are records of medicines received in the home but records for some weekly packs received are missing so there is not a complete audit trail. Only the dates are included but no quantities. Records of medicines returned to the pharmacy for disposal were not in the home at the time of the inspection so could not be checked. There was an asthma inhaler in the cupboard but no record on the current medicine chart. This was prescribed to use as required. No reference was found in the notes about this. The manager said this was not needed now and could be returned. There should be better records for treatments with medicines. One resident has medicines in a liquid form because of swallowing difficulties. This is noted in the care plan but more information is needed so that it is quite clear how medicines are given with a thicker liquid to prevent choking. Some doses are measured with a pipette but a member of staff did not describe a good method of using this correctly. Care records are in a number of different places. It is difficult to see what care is provided with records in so many different places. There are some new person centred plans, which provide a section to include issues about medicines. Some completed sections were seen for some residents. Information about medicines for one resident was different to that on the medicine chart. This could be because the total daily dose was noted rather than the actual dose and times of day. For another resident information about dose changes for one medicine were not consistently recorded. There was various information to indicate either a 10mg or 15mg total daily dose. A subsequent telephone conversation with the manger indicated a consultant had verbally authorised the dose recorded on the medicine chart but there were no records about this. For the same person there was little information describing how to use an occasional dose of a sedative for ‘panic / anxiety / agitation’. This was only rarely used and one member of staff described when she would consider giving this. One resident self-administers a medicine and goes to the doctor himself and staff have no involvement. This approach is encouraged but a risk assessment must be in place to check that this is always a safe arrangement for the resident and others in the home. Some staff have completed and others are studying safe handling of medicines course (college led) but do not complete this before they are allowed to deal with medicines. Staff have induction training about medicines but the only records were a ticked box on a common induction checklist. We have published on our website guidance about training care staff to give medicines safely. There was no list of staff authorised to give medicines with their sample signatures and initials they use to sign medicine records. The Granleys DS0000016610.V296781.R01.S.doc Version 5.2 Page 19 Medicines are stored in a locked cupboard but this is in poor condition and not very secure. There was a small pot of loose tablets left in here and loose sachets of a medicine that presumably had been taken out of the labelled box in which supplied. A lot of medicines were also stored in a locked filing cabinet. There were excessive amounts of medicines in here waiting return to pharmacy. This also indicates poor ordering and stock control and is not safe. Medicines for internal and external use were kept together so there is a risk of cross contamination. A filing cabinet in this location is not a safe place to store so many medicines. The home orders prescriptions themselves from the surgeries but the prescriptions are not checked in the home before sending to the pharmacy (as recommended by the Royal Pharmaceutical Society). Details were given to the manager to obtain a copy of these guidelines. The date is not written on medicine containers (other than the MDS packs) when first opened to use. Stock cannot be rotated properly or checks made for correct use without this information. There was no recent edition of a medical reference book (BNF). The Granleys DS0000016610.V296781.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22-23 (Adults 18-65) and Standards 16-18 & 35 (Older People) are: 22. 23. Service users feel their views are listened to and acted on. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted on. (OP NMS 16) Service users’ are protected from abuse, neglect and self-harm. Service users legal rights are protected. (OP NMS 17) Also Service users are protected from abuse. (OP NMS 18) Also Service users financial interests are safeguarded. (OP NMS 35) The Commission considers Standards 22-23 (Adults 18-65) and Standards 16-18 and 35 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 (Adults 18-65) and 16-18 and 35 (Older People) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. By using a mixture of text and symbol the complaints procedure would be more accessible to people living at the home. The home is protecting people who live there from abuse by providing appropriate training for staff. EVIDENCE: The home has a complaints policy and procedure in place. This procedure needs to be reviewed to include reference to the Commission for Social Care Inspection. People living at the home indicated that if they have concerns they would speak to staff. Information about how to make a complaint should be produced in a format appropriate to the needs of people living at the home. It is recommended that the registered manager research ways in which the procedure can be produced in a format using text, symbol or photograph. The home has not received any complaints. The Granleys DS0000016610.V296781.R01.S.doc Version 5.2 Page 21 The home has copies of “No Secrets” and the Department of Health’s “Protection of Vulnerable Adults”. Staff have access to training in the protection of vulnerable adults from abuse. Refresher training is also provided. Training certificates are kept on their personal files. Discussions with staff confirmed their understanding of abuse and what their responsibilities are in relation to reporting suspected abuse. The Granleys DS0000016610.V296781.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 (Adults 18-65) and Standards 19-26 (Older People) are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users live in a safe, well-maintained environment (OP NMS 19) Also Service users live in safe, comfortable surroundings. (OP NMS 25) Service users’ bedrooms suit their needs and lifestyles. Service users own rooms suit their needs. (OP NMS 23) Service users’ bedrooms promote their independence. Service users live in safe, comfortable bedrooms with their own possessions around them. (OP NMS 24) Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Service users have sufficient and suitable lavatories and washing facilities. (OP NMS 21) Shared spaces complement and supplement service users’ individual rooms. Service users have access to safe and comfortable indoor and outdoor communal facilities. (OP NMS 20) Service users have the specialist equipment they require to maximise their independence. Service users have the specialist equipment they require to maximise their independence. (OP NMS 22) The home is clean and hygienic. The home is clean, pleasant and hygienic. (OP NMS 26) The Commission considers Standards 24 and 30 (Adults 18-65) and Standards 19 and 26 (Older People) 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 and 30 (Adults 18-65) and 19 and 26 (Older People) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The environment is homely and comfortably furnished. There is an ongoing maintenance and refurbishment programme in place to make sure that the home is safe and well maintained. The services of a dedicated cleaner ensure that the home is clean and hygienic. The Granleys DS0000016610.V296781.R01.S.doc Version 5.2 Page 23 EVIDENCE: Since the last inspection a maintenance firm have been employed to provide day-to-day repairs to the home. The registered manager said that this has significantly improved the way in which repairs are dealt with and managed. During the visit a problem was identified by staff and promptly reported to the maintenance firm. An environmental health visit was carried out a week prior to the inspection and two recommendations were made in relation to covering pipes in the kitchen and painting a window. The latter had been completed. A walk around the home was carried out and all bedrooms inspected. The following issues need to be dealt with: • • • • Downstairs toilets – there was no soap or paper hand towels. These must be provided room 4 – the towel rail and the sink support need to be attended to old Office – the toilet seat needs to be replaced a fire exit in one room was blocked with a chair – these were removed during the inspection but this door needs to be kept clear. Personal rooms were pleasantly decorated and people living at the home said that they are involved in the choice of colour scheme. At the time of the visit the home was clean and tidy. A cleaner is employed to maintain the home and to support people living there to keep their rooms clean. The laundry is in an outhouse at the rear of the home. Colour coded mops and buckets are used. Hazardous products are locked away and COSHH data sheets are in place. The Granleys DS0000016610.V296781.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 (Adults 18-65) and Standards 27 – 30 & 36 (Older People) are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users are supported by competent and qualified staff. Service users are in safe hands at all times. (OP NMS 28) Service users are supported by an effective staff team. Service users needs are met by the numbers and skill mix of staff. (OP NMS 27) Service users are supported and protected by the home’s recruitment policy and practices. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users’ individual and joint needs are met by appropriately trained staff. Staff are trained and competent to do their jobs. (OP NMS 30) Service users benefit from well supported and supervised staff. Staff are appropriately supervised. (OP NMS 36) The Commission considers Standards 32, 34 and 35 (Adults 18-65) and Standards 27, 28, 29 and 30 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34 and 35 (Adults 18-65) and 27,28,29 and 30 (Older People) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff do not have the skills or training to meet the changing needs of the people living at the home, which may put people at risk. Recruitment and selection procedures although better need to be improved to ensure that people living at the home are safeguarded from possible abuse. EVIDENCE: Concerns raised at previous inspections focussed on the number of hours worked by the registered manager to cover shifts. She confirmed that she only works shifts in an emergency. Rotas verified this. There was evidence The Granleys DS0000016610.V296781.R01.S.doc Version 5.2 Page 25 that on occasions the registered manager has worked waking nights. This will continue to be monitored. Staff discussed the NVQ programme that follows on from their induction programme. Completed induction programmes for new staff are kept on their personal files. The staff group is made up of a mixture of experienced and qualified staff and staff new to care. Four staff have NVQ Awards in Care. Staff were observed treating people living at the home with respect and dignity. Staff meeting minutes confirm that the registered manager addresses practice issues relating to treating people living at the home with dignity and respect. Three new members of staff have been appointed since the last inspection. Their personal files were examined. It appeared from the file of one person appointed in May that they had been appointed before their references were obtained but the acting manager felt sure that this had not been the case and that the date on the contract of employment was incorrect. Their induction programme was commenced on the day references and a CRB check were received. The two other files verified that staff were appointed after two satisfactory references had been obtained and either a povafirst check or CRB check had been received. Staff working without a CRB check are subject to restrictions as outlined in the National Minimum Standards. A new member of staff confirmed this. Evidence of a povafirst check was provided. The following shortcomings were identified and must be addressed: • • • the application form must ask for a full employment history any gaps in the employment history must be investigated evidence of identity and a photograph must be obtained. Staff confirmed access to a variety of training courses. Copies of their certificates are displayed in the office and kept on their personal files. Training provided this year includes protection of vulnerable adults, basic food hygiene, manual handling, safety awareness, risk assessment and person centred planning. Fire training has just been provided. Future training includes basic food hygiene, manual handling and first aid. The registered manager plans to introduce a training matrix to help her to monitor people’s training needs. The staff support people with an increasing range of complex and diverse needs as they are becoming older such as dementia. Training must be provided to staff in this area. It is also suggested that staff receive training in total communication, including makaton sign language and specialist tasks they may be asked to perform. The Granleys DS0000016610.V296781.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 (Adults 18-65) and Standards 31-34, 37 & 38 (Older People) are: 37. Service users benefit from a well run home. 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. (OP NMS 31) Service users benefit from the ethos, leadership and management approach of the home. Service users benefit from the ethos, leadership and management approach of the home. (OP NMS 32) Service users are confident their views underpin all self-monitoring, review and development by the home. The home is run in the best interests of service users. (OP NMS 33) 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 homes record keeping, policies and procedures. (OP NMS 37) Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. Service users rights and best interests are safeguarded by the homes record keeping policies and procedures. (OP NMS 37) The health, safety and welfare of service users are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (OP NMS 38) Service users benefit from competent and accountable management of the service. Service users are safeguarded by the accounting and financial procedures of the home. (OP NMS 34) 38. 39. 40. 41. 42. 43. The Commission considers Standards 37, 39 and 42 (Adults 18-65) and Standards 31, 33, 35 and 38 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42 (Adults 18-65) and 31,33,35 and 38 (Older People) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living at the home will benefit from improvements in the management review of policies and procedures. The Granleys DS0000016610.V296781.R01.S.doc Version 5.2 Page 27 The quality assurance system does not involve the views of people living at the home. Health and safety systems are in place that protect people living at the home from possible harm. EVIDENCE: The registered manager has a NVQ Level 4 in Care and the Registered Manager’s Award. She is continuing her professional development by attending Health and Safety, risk assessor and person centred planning courses. The registered manager needs to ensure that the statement of purpose, service user guide and complaints procedures are reviewed and updated. There was little evidence of a quality assurance system in place for the home. The registered manager said that people living at the home had taken part in surveys in the past but these could not be found. A quality assurance system must be put in place in line with Regulation 24, which was amended in June 2006 and came into force on 1st July 2006. A report detailing the outcomes of this system that must include people living at the home must also be produced. Health and safety systems are in place that monitor fire systems, fridge and freezers and temperatures of cooked food. It is recommended that water temperatures are tested from water outlets around the home on a regular basis in addition to the testing that takes place of bath water. The preinspection questionnaire confirmed servicing and testing of equipment in the home. Certificates were also examined. The Granleys DS0000016610.V296781.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. 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 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 2 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 2 36 X CONDUCT AND MANAGEMENT Standard No Score 37 2 38 X 39 2 40 X 41 X 42 3 43 X 2 3 X 2 X LIFESTYLES Standard No Score 11 3 12 2 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Granleys Score 3 3 2 3 DS0000016610.V296781.R01.S.doc Version 5.2 Page 29 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 YA1 Regulation 6 Requirement The registered person must ensure that the Statement of Purpose and Service User Guide are reviewed and that copies are forwarded to the Commission. Service users must have access to the new 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 registered person must ensure that all care plans are in place and are being regularly monitored and reviewed. The registered person must ensure that risk assessments are in place for people using: • making hot drinks • helping to cook or bake The registered person must ensure that the dignity of service users is respected by providing age appropriate activities. Make safe and effective DS0000016610.V296781.R01.S.doc Timescale for action 30/11/06 2. YA1 4(1)(c) Sch 1.8 30/11/06 3. YA6 15(c) 30/11/06 4. YA9 13(4)(c) 31/10/06 5. YA12 12(4) 30/11/06 6. YA20 13 31/10/06 Page 30 The Granleys Version 5.2 17 18 7. YA20 18 8. YA22 22(7) 9. YA24 23(2) 10. 11. YA34 YA35 19(1) Sch. 2.1,6 18(1)(c) 12. YA39 24 arrangements for recording, handling, safekeeping, safe administration and disposal of medicines received to address and audit the issues identified in the report. Keep complete and accurate records for the receipt and administration of all medicines. Provide full training and assess staff as competent to give medicines safely before they undertake these duties. The complaints procedure must include reference to the Commission for Social Care Inspection. The registered person must ensure that the environmental issues identified in the standard are actioned. The registered person must obtain proof of staff identity and a full employment history. 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. 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. 31/12/06 31/10/06 30/11/06 30/09/06 31/03/07 31/03/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations DS0000016610.V296781.R01.S.doc Version 5.2 Page 31 The Granleys 1. 2. 3. YA6 YA6 YA7 Care plans should reflect needs identified in assessments. Consent for staff to manage finances and administer medication should be recorded in care plans. When a meal out replaces a meal that would normally be provided by the home then this should be paid for out of petty cash. Likewise staff meals should be paid for out of petty cash. The policy and procedure for management of service users’ money and financial affairs should be reviewed. The skills of staff could be used more effectively. Provide an up to date edition of the British National Formulary. Arrange to see the doctors’ original FP10 prescriptions in the home The complaints procedure should be produced in a format appropriate to the needs of service users using text, symbol and/or photograph. Staff should have training in total communication, makaton and any specialist tasks they may perform. Temperatures of water outlets around the home should be tested regularly. 4. 5. YA12 YA20 6. 7. 8. YA22 YA35 YA42 The Granleys DS0000016610.V296781.R01.S.doc Version 5.2 Page 32 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.V296781.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!