Inspection on 28/05/08 for The Grove

This inspection was carried out on 28th May 2008.

CSCI found this care home to be providing an Adequate service.

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 Grove 21/05/09

The Grove 19/06/07

The Grove 17/10/06

The Grove 14/02/06

The Grove 19/07/05

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE The Grove 181 Charlestown Road St. Austell Cornwall PL25 3NP Lead Inspector Megan Walker Unannounced Inspection 11:00 28th May 2008 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Grove DS0000063217.V364851.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Grove DS0000063217.V364851.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Grove Address 181 Charlestown Road St. Austell Cornwall PL25 3NP 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) 01726 76481 01726 67457 thegrove@fastmail.com Venetian Healthcare Ltd Manager post vacant Care Home 38 Category(ies) of Old age, not falling within any other category registration, with number (38) of places The Grove DS0000063217.V364851.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Old age, not falling within any other category (Code OP) The maximum number of service users who can be accommodated is 38. 19th June 2007 Date of last inspection Brief Description of the Service: The Grove is a care home registered to provide care and accommodation for up to thirty-eight people who have care needs within the categories of Old Age, not falling within any other category (38), and either gender. The Grove is not registered to provide intermediate care or nursing care. It does not have the specialist categories to provide care for people with significant dementia or mental frailty needs. The Grove also offers respite care for older people to have a short break, and day care for local older people The Grove is situated within its own grounds, on the main road into Charlestown. It is a large home that has been successfully modified over the years to provide residential care. It has recently undergone a major refurbishment to extend and improvement the facilities, offering an increase in the number of people who can be accommodated at the home. Some of the bedrooms have a sea view, a balcony or a patio. The majority of the bedrooms have an en-suite toilet and wash hand basin. Some have an en-suite bathroom. There is a shaft lift and stairs to access the bedrooms on the first floor. The home has a large garden that the people using this service can use. Car parking is available in the grounds of the home. The current scale of residential fees is £350.00 to £640.00 depending on assessment of care needs, room size, facilities and location within the home. These fees do not include hairdressing, chiropodist, telephone, newspapers and magazines, toiletries and personal sundries. Information about additional The Grove DS0000063217.V364851.R01.S.doc Version 5.2 Page 5 charges is available in the Service User’s Guide (brochure) provided by the home. This information was given to the Commission for Social Care Inspection (CSCI) in May 2008. The Grove DS0000063217.V364851.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was a Key Inspection undertaken by one regulation inspector. The fieldwork part of this inspection was unannounced and took place on Wednesday 28th May 2008 between 11:00 and 18h15. This visit included talking to two people who use this service about the care they receive and what it is like living at the home, and eight staff about their duties and working at The Grove. We also observed the interactions between staff and people who use this service. There was a tour of the premises, and inspection of care plans, staff files, medication and other records and documentation. The home does not currently have a registered manager. However a newly appointed manager, the deputy manager and the administrator of the home were able to provide relevant information such as the day-to-day routines as well as the management and administration of the home. The Registered Provider arrived for the end part of this visit. She was able to provide useful background information as well as her plans for the future of the home. In addition other information used to inform this inspection: • The previous inspection report • The service history • All other information relating to The Grove received by the CSCI since the last inspection. Surveys were sent to the home for people using this service, and families, advocates and representatives to complete. The CSCI received back – • 13 People who use this service “Have Your Say About The Grove” Care Homes Surveys • 1“Relatives/Visitors” “Have Your Say About The Grove” Care Homes Survey The Annual Quality Assurance Assessment (AQAA) to be completed by the manager and/or Registered Provider was not due back to the CSCI until after this inspection. Self-assessment of this service therefore was not available to inform this report and inspection. Five requirements and three “Good Practice” recommendations were made as a consequence of this inspection. What the service does well: People using this service who returned surveys to the CSCI wrote: “ The atmosphere here is very pleasant - it is not home, but it is second-best! The Grove DS0000063217.V364851.R01.S.doc Version 5.2 Page 7 “On the whole the atmosphere in the home is very good, the staff are all very kind and obliging” “Well organised daily activities. [The Activities Co-ordinator] is always there to support and encourage residents. I for one would not like to be without her.” “Care and support is excellent” A relative told us that the care home provides “General care; don’t think it could be better.” The Grove provides a comfortable environment for people who are mentally well and require twenty-four hour residential care for reasons of old age, and no other reason. People living here are supported to maintain their independence and those who are able to go out alone are encouraged to do so. Since March 2008 there has been an Activities Co-ordinator employed to work Monday to Friday 10:00 to 16:00. In consultation with people’s preferences she provides group activities every afternoon and 1:1 time with people in the mornings. Her enthusiasm and energy has proved very popular with the people using this service. What has improved since the last inspection? What they could do better: Two requirements were made at the last inspection. These had not been met by the time of this inspection despite a due date for August 2007. Compliance with requirements made at previous inspections is mandatory and these must be met to avoid enforcement action being necessary. All training in “Safeguarding Vulnerable Adults” must be up to date and staff must understand what they have to do should an incident occur. This will ensure that the relevant authorities can take immediate and suitable action for the protection of the people using this service. It will also ensure that all staff are trained to recognise any form of abuse so that people using this service are protected from harm. Robust measures must be put in place to ensure that all staff employed to work at the home understand that they have a duty of care to the people using this service. (See Complaints and Protection Staffing) The Grove DS0000063217.V364851.R01.S.doc Version 5.2 Page 8 Complete checks on potential employees must be completed to ensure that the people using this service are protected from harm and abuse. (See Staffing) Care plans could be more person-centred and include risk assessments relevant to individuals rather than a general risk assessment. (See Health and Personal Care) It is important that the communication between the management team and the staff teams is open and transparent in order to maintain positive outcomes for the people using this service. (See Management and administration) 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 Grove DS0000063217.V364851.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Grove DS0000063217.V364851.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2,3,4,5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People choosing to use this service and their families can feel confident that their needs will be assessed before moving into the home and that they can have the information they need to make an informed choice about where to live. EVIDENCE: Anyone considering moving in to The Grove is offered an informal tour of the home and an opportunity to talk to people using the service. Their family or friends may do this on their behalf. The Grove also provides a respite care service and day-care for people living in the local community. This has been advantageous for people seeking residential care as they already know of the care home. The Grove DS0000063217.V364851.R01.S.doc Version 5.2 Page 11 A copy of the home’s Statement of Purpose (also called a brochure) and scale of care fees are given to everyone moving into the care home. We were shown a copy of this and told that it was currently being revised and updated. The home has its own web site – www.grove-charlestown.co.uk . This too was being updated with a change of logo and additional information added. We saw a sample copy of the new proposed brochure which will soon be available for prospective residents. We looked at a sample of care files and found the previous Registered Manager or a senior staff member had completed assessments of care needs. This was a tick box style list rather than a person-centred individual care assessment. The manager told us that this pre-assessment form has recently been reviewed and revised to provide more personal information. She also said that the new form was not a tick box style form. The current scale of residential fees depends on room size, facilities and location within the home, and assessment of care needs. The manager explained that this is being re-structured to demonstrate any changes in a person’s care needs. Fees would be banded according to care needs. We looked in detail at four care files. We found that three had a contract with terms and conditions of residency at The Grove. People can come to The Grove for a short stay for a period of respite. The respite care fee now has structured rates. There are plans to introduce a contract for those people who stay on respite care. The deputy manager told us that prospective residents would be told verbally that a place was available for them at The Grove. By the end of this visit a formal letter to send to prospective residents had been produced. This letter offered a place at The Grove, and would confirm the identified assessed care needs and how these could be met at the care home. The Grove DS0000063217.V364851.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use this service can feel confident that a staff team that is respectful and sensitive will ensure that all their health, personal and social care needs are met. EVIDENCE: Someone living at The Grove wrote “Care and support is excellent”. In the surveys returned to the CSCI, people using this service felt that they usually received the care and support that they needed. (See Staffing) We chose four people, both men and women, to look at their care files and care generally because they were, for example, people with more complex needs (such as health care needs), and/or people with changing needs. Each care file seen had a photograph of the person whose file it was, and the person’s preferred name. There was a general assessment of care needs, and a care plan that was reviewed monthly. The care plans were based on offThe Grove DS0000063217.V364851.R01.S.doc Version 5.2 Page 13 the-shelf documentation. They were therefore tickboxes, providing little personal information. The review was a date and a signature however it was not evident that this had been done with the individual and/or a family member. It was not evident where, if any, changes had been made to the care plan. As well as a general care needs assessment there were records to record weight and and body mass index, continence management, assessment of pain, a nutritional screening tool, a falls risk assessment and a handling assessment. Notes made following doctors’ visits were kept separately for ease of access. The new manager proposes to change the care plan documentation currently in use. It is her intention that the new format will be more personal and specific about individual needs, preferences, likes and dislikes. The new care plans will also include social histories so care staff have important background information about each individual person to whom they are providing care. The medication was seen kept in lockable trolleys that were tethered to the wall in a locked room. A keypad was fitted on the door to ensure that it is kept locked at all times. Controlled medication was kept in a separate lockable box in one of the trolleys. The medication ‘fridge’ temperature is checked every morning. We found medicines in the medication fridge that had no opening date recorded on them and were possibly out of date from the information on the dispensing labels. Three people’s other medicines were checked. These were all in date and the correct number of tablets was in the boxes. Inspection of the medication record sheets found they were all signed appropriately when medication had been given. Not all medication record sheets had a photograph of the individual. Known allergies were recorded on the individuals medication record. The deputy manager explained that people staying for respite could look after their own medication. She confirmed this option was offered to everyone living in the home. Two senior carers and the team leaders are trained in the handling and administration of medication. The local pharmacy that dispenses the medication provides a review of all the medication at the home approximately every six months. Locks were provided so those people who wished to lock their room could do so. There was no evidence of agreements for keys on people’s care files. There was no evidence about the type and use of door locks for bedrooms to form part of individual care plans. When we toured the building we found that some bedroom doors were unlocked. The door locks were ‘Yale’ type locks so required a ’master’ key to open them in the event of an emergency. People who go out regularly could have a key for the front door. The front door has an electronic system that requires a key fob. A staff member told us that people who go out regularly could have a front door key fob, and also families who visit regularly. The Grove DS0000063217.V364851.R01.S.doc Version 5.2 Page 14 We spoke to people as we walked around the building and asked them about living in the home. Everyone we asked was positive about the staff and felt that they were treated well, with respect, and their care needs were being met. Surveys returned to the CSCI commented that staff generally listened and acted on what had been said. (See Staffing) The Grove DS0000063217.V364851.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People living at The Grove are satisfied with their lifestyle and are encouraged to exercise choice and control over their lives. People are supported to continue to enjoy familiar supportive relationships with family and friends, and within the local community. EVIDENCE: During this visit people using this service were seen either in the sun lounge or in their bedrooms. They told us they could come and go as they wished. We also saw families coming into visit people in the home. Everyone we spoke to was complimentary about her or his room. They told us that they were comfortable and bedrooms we saw were personalised with the occupant’s own possessions arranged as each individual preferred. On the afternoon of this visit a group of people had gathered in the sun lounge for a word game organised by the activities coordinator. As the afternoon progressed we observed that everyone sitting in the room was joining in and contributing to the game. In the surveys returned to the CSCI people told us The Grove DS0000063217.V364851.R01.S.doc Version 5.2 Page 16 that they could choose to join in activities if they wished. Comments we received included: “We have an excellent Entertainments Officer.” “Well organised daily activities.” “If I wish to attend any activities I can.” The activities coordinator told us that she had started in March this year. She had consulted with people living in the home about their preferences and dislikes. Most days there was one main activity done as a group and in the mornings she spent time doing one-to-one sessions with individual residents. She said she tried as much as possible to involve visitors so that people did not have to choose between spending time with their visitor or joining in an activity that they enjoyed. She said this had proved very popular! Anyone coming to the home for day care was also encouraged to join in. Alternate weeks an outside contractor comes into the home. This includes local choirs, instrumentalists, a storyteller, a dance troupe, and Pat-A-Dog. The local council provides a travelling library every four weeks. There are trips out in the homes minibus and the homes car. For example, there have been trips to the theatre, garden centres, local supermarket, flower festivals, the local ‘pub’, and recently a group went out for a fish and chip supper. The activities coordinator produces a monthly newsletter available in large print for anyone with a visual impairment. She has also produced a large version of ‘bingo’ cards, and letters of the alphabet that can be used as a prompt during word games. The activities coordinator said that it was important all the activities were adapted to suit everybodys needs to ensure that people had the opportunity to participate. She has introduced the sale of greetings cards and stamps and also set up a daily shopping trip (there used to be a small shop within the home). This enables people to have more choice as well as products in date. There is a high church communion and a Bible study held at the home monthly. One evening a month the Salvation Army lead a service of worship. The registered provider plans to include this information in the revised service users guide, explaining that is although the home is not a specific faith home, links are maintained with local Christian churches, and the major Christian festivals are celebrated within the home. On the day of this visit everyone living at The Grove was white and only one person was not British. The people using this service were predominantly was Christian or agnostic. Two cooks are employed to work at The Grove, alternate shifts from 0800 to 1800 daily. There is kitchen assistant to assist with clearing the kitchen and washing-up. People using this service choose their meals the day before. They generally do this at lunchtime whilst waiting for their lunch. Breakfast time people can choose to have it either in their bedroom or to go down to the dining room. For lunch and supper most people go to the dining room. On the day of this visit only one person was having lunch in their bedroom and this was because they were poorly. The comments about the food in surveys received by the CSCI were not complimentary. One person who has particular The Grove DS0000063217.V364851.R01.S.doc Version 5.2 Page 17 dietary needs asserts they were not catered for particularly well. The general comment in the surveys indicated that the food was dependent on which cook was on duty. One person wrote, You only have to look at the food and you can see who it is prepared by.” People using this service did not feel able to complain about the quality of the food being prepared for them. One comment was a lot complain amongst ourselves but thats as far as it goes, they wont say anything to the right people.” The Grove DS0000063217.V364851.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The people living at The Grove and their families and friends can feel confident that any issues of concern or complaints raised by them will be dealt with appropriately. All training in “Safeguarding Vulnerable Adults” must be up to date and staff must understand what they have to do should an incident occur. EVIDENCE: Everyone who returned a survey to the CSCI ticked that they knew to whom they should raise any concerns or complaints. A Residents’ Meeting is held about every three months. This offers an opportunity for people using this service to talk about issues important to them, their likes and dislikes. Minutes of these meetings are kept in the manager’s office. The Complaint’s procedure is in the home’s Service User’s Guide. This needs updating to reflect the change of manager and the contact details for CSCI. At the last inspection a requirement was made that all staff be trained to ensure that they have the knowledge and understanding of adult protection issues to protect people using this service from abuse and harm. This The Grove DS0000063217.V364851.R01.S.doc Version 5.2 Page 19 requirement had not been met by the time of this inspection visit. This is a matter of serious concern because it puts people using this service at risk of harm. The new manager stated that she had arranged safeguarding training for all staff with the local authority in July and September 2008. The Grove DS0000063217.V364851.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25, 26 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The physical design and layout of the home enables people who use this service to live in a well-maintained and comfortable environment. Peoples’ private accommodation was personalised with their own possessions around them. EVIDENCE: Since the last inspection the refurbishment programme has been completed. The bedrooms known as “the lodges” have either an en-suite bathroom or access to a designated, separate bathroom. The external passageway in front of the lodges has been glazed thus providing extra security and protection in cold or bad weather. A number of new rooms have been built all with en-suite bathrooms or wet rooms. Most of these rooms are larger than the required The Grove DS0000063217.V364851.R01.S.doc Version 5.2 Page 21 size of the national minimum standards. A wet room has been constructed on the ground floor with a walk-in shower and toilet providing easy access for anyone using a wheelchair. Around the garden, a handrail has been installed so people are now able to walk around the garden and have access to areas that were unsafe to do so previously. The new build and refurbishment has been done in such a way that there was no apparent extension to the building. All the bedrooms have a lockable box fixed into a drawer so people have somewhere safe to keep valuable items. Telephone lines can be installed in bedrooms if people so wish. Bills are sent directly to the person. Most people have their own television in their room. The home’s administrator is currently looking into the installation of high definition-digital television for the home. A tour of the premises found that bedrooms were personalised to suit its occupant, and people had brought in their own possessions including pieces of furniture and soft furnishings. Specialist equipment was available for those people who required it. The main kitchen is commercial in size with a separate preparation kitchen. There was good storage space, and eight ‘fridges’ and freezers. All food deliveries were registered and recorded. Stock was rotated. Any food brought in by relatives was also recorded. The laundry is large with two industrial washing machines and a tumble dryer. The laundry and housekeeping staff are responsible for all personal clothing, sheets and bedding. Any clothing that is damaged during washing is replaced however people are encouraged to ask their families to take any items that require dry cleaning. People have a choice about duvets or sheets and blankets on their bed. They can bring in their own bedding if they prefer. Each room has a dirty laundry bag that is collected by the housekeeping staff daily. Additionally there are five laundry trolleys (one on each landing) for any items ‘missed’ on the collection rounds. In the laundry there are named baskets for clean and ironed items. There is a room designated for use for hairdressing. It is also used for “pamper sessions” (manicures, eyebrow shaping, etc), and by the chiropodist. During a tour of the premises we found two storerooms unlocked. Each had a hot water tank and hot water pipes that were not lagged or boxed. The manager was advised that these were a risk to people using this service and at minimum the doors must be kept locked. By the end of this visit the manager confirmed that all the storerooms were locked and staff told to ensure these storerooms were kept locked. We found that some bedroom doors didn’t close properly. The manager was advised that this was a risk in the event of a fire to the occupants of those The Grove DS0000063217.V364851.R01.S.doc Version 5.2 Page 22 rooms. Later during this visit the maintenance person was observed checking bedroom doors. A staircase had chains across it at the top and at the bottom. We were told that this was for the safety of a resident and that the chains had been successful in acting as a deterrent. The deputy manager was aware that this was a form of restraint however she confirmed there was a written risk assessment on the person’s care plan. The cupboard housing all dangerous and harmful substances was found locked. The home was found to be clean and pleasant smelling throughout with the exception of one bedroom identified to the manager at the time of this visit. The Grove DS0000063217.V364851.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People using this service are cared for by competent staff however the staffing levels need to be reviewed to ensure that the numbers on each shift reflect people’s needs. People using this service need to know that they are protected and safe because complete checks are made for all employees of the care home. Storage of staff information needs to be more robust and straightforward. EVIDENCE: On the day of this visit thirty-three people were employed to work at The Grove. They were in teams for care, housekeeping and laundry, kitchen, and maintenance. Inspection of the rota found that there were five care staff in the morning, two in the afternoon and two in the evening/overnight. The housekeeping staff are responsible for all the cleaning and laundry, and the cooks are employed to work all day so care staff do not have to prepare meals. The activities co-ordinator works five hours a day, Monday to Friday. Additionally there is a manager, a deputy manager and a receptionist/administrator on duty during the day. The Grove DS0000063217.V364851.R01.S.doc Version 5.2 Page 24 Surveys returned to the CSCI people using this service felt that they usually received the care and support that they needed, and that staff generally listened and acted on what had been said. Four people felt this didn’t happen when staff were busy. One person wrote: “They sometimes forget until asked again - ? and again?” Another person wrote: “You have to run around to find someone to discuss anything that is not everyday affairs. When you go to the office there is usually two or three people there which is rather embarrassing.” On the day of this visit thirteen people had been assessed as having a high level of care needs, and five people were dependant on two carers for moving and transferring. With only two carers working in the evenings, this means that people are at risk. It was unconfirmed what time people would prefer to go to bed (this was variable between 2030 and midnight), or how many would require assistance to get ready for and/or get into bed. There was nothing documented on individual care plans to show that people were asked if they had a preferred time to get up/go to bed. The manager expressed concern that with the present rota of two staff on duty during the evening, this means an increased risk for people using this service when one carer is doing the medication round. The manager said she would like to increase the number of care staff working in the evenings by introducing a ‘twilight’ shift. This would provide an extra staff member for the evening, from 17h00 until 21h00. The Registered Provider said that she would increase care staffing numbers when there was an increase in the numbers of people suing this service. The Registered Provider was open to negotiation for changes to the current rota. We selected five staff files for inspection, two of which were for recently recruited staff. We found that recruitment checks were not robust or consistent. Only one file had a photograph of the staff member. Four had completed an application form and one had sent a “curriculum vitae” with a covering letter. Only two had dates of previous employment and there was no evidence to show that this information was sought at interview. Two files had two written references, two only had one written reference and one file had no references. Three files had a job description and four had terms and conditions of employment at The Grove. We saw evidence of two police checks and three PoVA checks (a check to ensure that people being employed to work in the care sector are not named on a list of people who are not allowed to work with vulnerable people). The administrator showed us evidence of email copies of police checks. The deputy manager confirmed that no one worked alone at the home until satisfactory checks had been done. The current arrangements for filing staff information is multipart so pose problems to find information easily. The manager said she would like to review the current arrangements so all the information is pulled together in one file per each member of staff. She has organised an Employees’ Handbook to be given to all staff. She is looking at setting out questions to be asked at interviews that are more relevant to the specifics of each job. The Grove DS0000063217.V364851.R01.S.doc Version 5.2 Page 25 Staff meetings are held monthly and team meetings fortnightly. Staff receive supervisions and an annual appraisal. Fifty percent of the care staff has a minimum Level 2 National Vocational Qualification (NVQ) in Care. Training on safeguarding and whistle blowing has been arranged for all staff in July and September this year. The manager is also keen for all staff to attend equality and diversity training. All care staff recently completed a basic food hygiene course. Four care staff have a certificate for First Aid At Work. There was a record of regular fire training for all staff. The manager is planning to review the training programme to make it clearer and easier to identify what staff have done and when so it is clearer when training is due. She plans to introduce the ‘Skills For Care’ Induction programme for all new staff. She would like to use a different training company in the future. The Grove DS0000063217.V364851.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Robust systems need to be pro-actively promoted by a competent and capable manager who is keen to raise standards and achieve positive outcomes for people using this service and the staff working here. EVIDENCE: There have been significant staff changes over recent months due to the Registered Manager and the home’s administrator leaving within a few weeks of each other, and the internal appointment of a deputy manager who has been largely responsible for managing the home until the recent appointment of a new manager. The Grove DS0000063217.V364851.R01.S.doc Version 5.2 Page 27 A manager with many years of experience managing care homes had recently been appointed. By the time of this visit she had been working at home for four days. She was keen to take on the task of making positive changes for the benefit of the people who use this service. People using this service and their families were recently sent a survey about the service they receive. There had not been extended to visiting health and social care professionals, and other regular visitors to the home. An Open Day was held at the home in April this year. This had offered an opportunity for local people to visit the home and view the new facilities. The Registered Provider confirmed that visitors had been complimentary and she had received a lot of verbal feedback form this event. The CSCI has introduced a legal document called an Annual Quality Assurance Assessment (AQAA). This is an annual report sent to the CSCI by all service providers with information about the provision and quality of their service, and how the people using the service are involved in deciding what and how the service is offered and provided. This was not due back to the CSCI until after this inspection. Self-assessment of this service therefore was not available to inform this inspection and report. People can choose to manage their own finances or their representative on their behalf. The administrator holds small amounts in a safe for personal spending if people wish her to do so. The monies held on the premises were secure. We did a random check on the day of this visit and found one account incorrect. The administrator undertook an audit of this account and the error was found and rectified immediately. People also have lockable storage provided for them in their bedrooms. The fire safety log and training record was up to date. This was comprehensive in identifying what had been done and who had done what. There is a health and safety check four times a year. The cupboard for storing hazardous substances was locked. Information about using these products was available for staff to refer to when needed. There was a poster identifying where to use safely different products. The laundry was organised systematically to ensure there was a reduced risk of cross infection. All the laundry bins were clearly marked. There were plans to review and update the policies and procedures to ensure they were specific to The Grove. Incidents that affect the health, safety and/or well being of people using this service are reported to the CSCI as required by Regulation 37 of the Care Homes Regulations 2001. Matters of concern identified during this visit were rectified at the time. The Grove DS0000063217.V364851.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 Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 The Grove DS0000063217.V364851.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? 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 OP7 Regulation 15(1) Timescale for action Unless it is impracticable to carry 30/09/08 out such consultation, the registered person shall, after consultation with the service user, or a representative of his, prepare a written plan as to how the service user’s needs in respect of his health and welfare are to be met. This requirement is outstanding from the last inspection (Due by 31/08/07) All medicines must be stored in 30/08/08 accordance with the current storage regulations to prevent unauthorised access so potentially leading to nonavailability of medicines for people in the home. This includes any medicines that require refrigeration. These must be dated when opened and disposed of if the recommended opening time expires before the medicine is finished. The registered person shall make 30/09/08 arrangements, by training staff or by other measures, to prevent service users being harmed or DS0000063217.V364851.R01.S.doc Version 5.2 Page 30 Requirement 2. OP9 13(2) 3. OP18 13(6) The Grove 4. OP29 Sch. 2 5. OP33 12 Sch1 (10) suffering abuse or being placed at risk of harm or abuse. This requirement is outstanding from the last inspection (Due by 31/08/07) The registered person must ensure that all relevant and necessary employment checks, including criminal records bureau checks, two written references and dates of employment, are I place prior to appointing new staff. This was a recommendation at the last inspection The Registered Person shall establish and maintain a quality assurance system that will identify shortfalls in meeting the Regulations and establish the residents’ level of satisfaction with the care services they receive in the home. This must also be extended to all visitors to the home including health and social care professionals, to establish their level of satisfaction with the care services being provided in the home. The results of all the surveys undertaken must be published and available to prospective residents and the CSCI. 30/09/08 30/09/08 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 OP1 Good Practice Recommendations To update the service users guide/statement of purpose DS0000063217.V364851.R01.S.doc Version 5.2 Page 31 The Grove 2. 3. OP15 OP27 document to include the philosophy of care at the home for example. This recommendation is carried over from the last inspection To consult with the people using this service about the standards of food provide for them and to be open to their suggestions and complaints. To consider revising the staff rota to better meet the needs of the people using this service. The Grove DS0000063217.V364851.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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