Inspection on 05/07/05 for The Granleys

This inspection was carried out on 5th July 2005.

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 but made no statutory requirements on the home.

Other inspections for this house

The Granleys 30/01/08

The Granleys 22/08/07

The Granleys 25/08/06

The Granleys 02/02/06

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 Marks Cheltenham Glos GL51 6SJ Lead Inspector Simon Massey Unannounced 05 July 2005 10:00 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 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 Stationary 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 v238391 d51_d03_s16610_thegranleys_v238391_050705_stage4_u.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service The Granleys Address 21 Griffiths Avenue St Marks Cheltenham Glos GL51 6SJ 01242 521721 Telephone number Fax number Email 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 Ranger Care Home 17 Category(ies) of Learning Disability (17) registration, with number of places The Granleys v238391 d51_d03_s16610_thegranleys_v238391_050705_stage4_u.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 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. Date of last inspection 05/03/05 Brief Description of the Service: The Granleys is a detached property approximately 1 mile from the centre of Cheltenham. The home provides care and accommodation to 17 adults with learning disiabilities.The house is set in large grounds and is a listed building. The accommodation is arranged over two floors and all of the rooms have ensuite facilities. The Granleys v238391 d51_d03_s16610_thegranleys_v238391_050705_stage4_u.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place on 5/07/05 and was undertaken by inspectors S.Massey and T.Harding, over a period of 4 hours. The manager and Provider were present for part of the visit. Service users were spoken to and observed in their daily activities within the home. A tour of the premises was undertaken and also records and files were examined. The inspectors also had contact with other statutory agencies involved with the home. The Commission will be meeting with the Registered Provider and Manager to discuss compliance with the requirements of this report. What the service does well: What has improved since the last inspection? What they could do better: The home needs to demonstrate that it is committed to meeting the National Minimum Standards and providing an improving standard of care and support. The Granleys v238391 d51_d03_s16610_thegranleys_v238391_050705_stage4_u.doc Version 1.40 Page 6 The home needs to plan for the future in order to ensure it can meet the increasing needs of the people living there. It needs to provide increased management hours to ensure that the leadership and direction is provided and that the care management systems are effective. The home needs to provide more structured and planned day care for the increasing number of service users who no longer attend local authority day care provision. The home needs to ensure that they have sufficient staffing levels to meet the assessed needs of the service users. 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 v238391 d51_d03_s16610_thegranleys_v238391_050705_stage4_u.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection The Granleys v238391 d51_d03_s16610_thegranleys_v238391_050705_stage4_u.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) These standards were not inspected during this visit. EVIDENCE: The Granleys v238391 d51_d03_s16610_thegranleys_v238391_050705_stage4_u.doc Version 1.40 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7&9 The care planning system in the home is insufficiently developed to ensure that future needs are met. EVIDENCE: The home needs to improve and develop its care planning system to ensure that future needs are identified and appropriate action is taken. Previous inspections have identified the need to improve the care planning system in the home so that is more “person centred” and identifies future needs and goals. A start has been made by some key-workers to identify interests or activities people may be interested in doing, but this seems to be being done outside the care planning and reviewing process that is in place. The care plans examined appear to change very little following reviews and still do not clearly identify goals and objectives. This is the result, in the view of the inspectors, of a lack of awareness and most importantly a lack of staff time to invest in the process thoroughly. Comments are made in the staffing and management standards about levels of cover. There are a significant number of service users whose needs are increasing due to the ageing process, and the home needs to have an effective system in place for assessing and reviewing needs to ensure that they can be met. The Granleys v238391 d51_d03_s16610_thegranleys_v238391_050705_stage4_u.doc Version 1.40 Page 10 There was evidence in the files of regular recording being completed. A requirement has been made previously that staff receive training in risk assessing and the manager stated that two staff were due to undertake training the following week. A sample of service user finances were examined and it was seen that people are required to pay for the staff meal if they go out for lunch or an evening meal. The home needs to produce written guidance on this for staff and service users. Records must show exactly what staff expenses the service users have paid for. The home must also review this policy to see whether it is possible to have a budget for these activities. Some receipts from the recent holiday did not contain enough detail as to what expenditure had been on. The Granleys v238391 d51_d03_s16610_thegranleys_v238391_050705_stage4_u.doc Version 1.40 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13&14 The home needs to provide more structured day care and leisure activities, based on assessed needs and individual choice. EVIDENCE: On the day of the inspection there were 8 service users at home for the day, which is the average number the home provides day-care for. This is largely unstructured with staff either undertaking supporting appointments or organising occupational activities within the home. There is generally three staff on duty for this, though one may be the manager. The home has been attempting to recruit staff in order to provide 4 staff on shifts through out the weekend until Sunday evening, when the home has assessed that only 3 are required. There was evidence that there had been an increase in some trips out but with such a large group living together the majority of time is spent at the home. It also means that some trips out have to be done in large groups. The home recently provided and supported a weeks holiday to a holiday camp. This however involved taking all the service users and a large group of staff. Whilst staff stated that the trip had been a success it would be preferable and The Granleys v238391 d51_d03_s16610_thegranleys_v238391_050705_stage4_u.doc Version 1.40 Page 12 better practice if people could be afforded more choice and given the opportunity to holiday in smaller groups. Service users may choose a holiday camp as their preferred holiday but a home of 17 service users and staff all going away for the week together appears to be somewhat institutional. The Granleys v238391 d51_d03_s16610_thegranleys_v238391_050705_stage4_u.doc Version 1.40 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18&19 The staff team provide a good standard of personal care and involve outside professionals for input and support. The assessment process in place is insufficient to ensure that changing needs are identified and the necessary support provided. EVIDENCE: These standards were examined in detail but some issues were followed up from the previous inspection. There was evidence of health needs being monitored and appointments being supported and outcomes recorded. The home has liaised with the Community Learning Disabilities Team to ensure that service users have access to this service if required. The manager showed the format that they were using to reassess one person’s needs and explained that they had been advised by a care manager involved to just complete this process on one person to start with. However, as mentioned in previous reports and again following this inspection, there is a need for this process to be completed on a number of service users as their needs are increasing. The Granleys v238391 d51_d03_s16610_thegranleys_v238391_050705_stage4_u.doc Version 1.40 Page 14 The Granleys v238391 d51_d03_s16610_thegranleys_v238391_050705_stage4_u.doc Version 1.40 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 23 The home have improved their recruitment process to incorporate the necessary checks but still need to ensure that new starters do not work unsupervised until this is appropriate. EVIDENCE: Since the previous inspection the home has ensured that all new staff are subject to a PoVA check before commencing employment. The home has obtained the relevant guidelines and the manager and Registered Provider are now aware that these checks are a required part of the recruitment process. The Granleys v238391 d51_d03_s16610_thegranleys_v238391_050705_stage4_u.doc Version 1.40 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) A detailed inspection of the environment was not undertaken during this visit. Reference to the maintenance of the building is made under the management standards. EVIDENCE: The Granleys v238391 d51_d03_s16610_thegranleys_v238391_050705_stage4_u.doc Version 1.40 Page 17 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 34&35 The home has a stable staff team that relate well to the service users. New staff are not given sufficient time to complete their induction and get to know the service users. EVIDENCE: On the day of the inspection there were three staff on duty, one of whom had started employment the previous day. Because the CRB check had not been returned on the new staff member they should not have been working unsupervised. Also, because they only commenced employment the previous day, they should also have been supernumerary to the shift numbers. The manager stated that they have trying to have 4 staff on the Saturday shifts and also the Sunday morning but needed to recruit more staff. The manager and deputy both work shifts and when this happens are part of the numbers for the shift and would be in charge of the home. When there is no management on duty there is no designated shift leader responsible for planning the shift. It is recommended that this is considered by the home. Staff were observed interacting positively with service users and organising some activities in the house. Drinks and meals were also prepared and some service users were supported to go for a walk. The Granleys v238391 d51_d03_s16610_thegranleys_v238391_050705_stage4_u.doc Version 1.40 Page 18 Staff are up to date with their required statutory training and were undertaking fire safety training on the afternoon of the inspection. The Granleys v238391 d51_d03_s16610_thegranleys_v238391_050705_stage4_u.doc Version 1.40 Page 19 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37&42 The manager does not have enough dedicated management hours to fulfil the requirements of her role to a satisfactory standard and have the opportunity to develop and improve the home. EVIDENCE: The manager currently works 3 care shifts per week and the deputy does all their hours on shift. The inspectors consider that this is an insufficient number of management hours. It is also inevitable that when the manager and deputy are working care shifts they will have to deal with management issues, which will impact upon the cover being provided for care. For the home to effectively manage and plan the care for 17 service users, manage and supervise the staff team and maintain a safe environment, it is essential that it has a manager whose primary responsibility is management and not care. The Granleys v238391 d51_d03_s16610_thegranleys_v238391_050705_stage4_u.doc Version 1.40 Page 20 This report has been critical of the care planning systems in the home and the inspector considers that this area of work alone requires considerable time and input from the manager on an ongoing basis. The home has failed to provide action plans within the required timescales following the previous 2 inspections. The Provider accepted responsibility for this but stated that all the required actions had been taken. This is not the view of the inspectors and some requirements have been carried over into this report. The home needs to develop in a number of areas if it is to meet more of the minimum standards and for this to happen it needs to have more management hours. It was also evident that there is a need for some administrative support as the manager currently has to undertake all their own administration. Previous inspections have required the home to arrange for the fire service to visit and review the fire precautions and evacuation procedures within the home. It was required that the same approach was made to the local Environmental Health Department to come and advise on the kitchen area and any other related matters. Neither of these requirements were implemented, but subsequent to this visit the inspector has had contact with both authorities and has been assured that inspections will be taking place within the near future. As at the last inspection it was found that some fire doors were not closing properly, though staff confirmed that they had been adjusted following the last inspection. The home does not employ its own maintenance staff and the responsibility for monitoring and arranging repairs appears to fall to the Registered Provider. Considering the size of the building and the fact that it is a Grade 2 listed building, a more ongoing arrangement for ensuring a safe environment that is well maintained and decorated would be preferable. The Granleys v238391 d51_d03_s16610_thegranleys_v238391_050705_stage4_u.doc Version 1.40 Page 21 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x x x x Standard No 22 23 ENVIRONMENT Score x 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 2 x 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score x x x x x x x Standard No 11 12 13 14 15 16 17 x 2 2 2 x x x Standard No 31 32 33 34 35 36 Score x x x 2 2 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Granleys Score 3 3 x x Standard No 37 38 39 40 41 42 43 Score 2 x x x x 2 x v238391 d51_d03_s16610_thegranleys_v238391_050705_stage4_u.doc Version 1.40 Page 22 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 6 Regulation 15(1) Requirement The home must continue to improve the care planning sytem in line with comments made in the report The home must provide written guidance for staff in relation to the expenses for meals out and the contribution made by service users The home must complete the work identifying the leisure interests of service users The home must ensure that ongoing assessments are completed to reflect the changing and incresing physical needs of service users The home must ensure that new staff do not work unsupervised until all checks have been completed as well as the the induction process The home must ensure that there is a minimum of four staff on duty during weekend shifts The home must provide additional management hours The home must action any reccommendations made following visits from the fire service and the enivironmental Timescale for action 31/10/05 2. 14 30/09/05 3. 4. 14 19 12(3) 14(2) 30/09/05 31/10/05 5. 23 19(1a) 31/08/05 6. 7. 8. 35 37 37 18(1a) 31/08/05 31/10/05 31/10/05 23 The Granleys v238391 d51_d03_s16610_thegranleys_v238391_050705_stage4_u.doc Version 1.40 Page 23 health department 9. 42 23 The home must ensure that there is a satisfactory system in place for monitoring maintenance and arranging repairs The home must ensure that all service user expenditure is fully recorded and accurately receipted 31/10/05 10. 14 17 Sch 4 30/09/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard 14 14 35 35 Good Practice Recommendations The home should consider whether it is possible to provide an activities budget to be managed by the manager The home should consider providing more choice to service users over their holday destinations The home should consider designating shift leaders for each shift in the abscence of management The home should provide administration support for the manager The Granleys v238391 d51_d03_s16610_thegranleys_v238391_050705_stage4_u.doc Version 1.40 Page 24 Commission for Social Care Inspection 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. 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